Carotid revascularization: an update.
Symptomatic extracranial internal carotid artery stenosis poses a high short-time risk of ischemic cerebral stroke, as high as 20% to 30% in the first three months. Timely performed carotid endarterectomy (CEA) has been shown to be highly effective in reducing this risk although, in recent years, there has been great interest in replacing this procedure with less invasive carotid angioplasty and stenting (CAS). In this update we review recent studies and provide recommendations regarding the indications, methods and timing of surgical intervention as well as the anaesthetic management of CEA, and we report on recently published randomized controlled trials comparing CEA to CAS. We also provide recommendations regarding the sometime neglected but important medical management of patients undergoing carotid intervention, including antithrombotic and antihypertension therapy, lipid lowering agents, assistance with smoking cessation, and diabetes control.
O'Kelly
Cian J
CJ
Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
Butcher
Ken S
KS
Marchak
B Elaine
BE
Findlay
J Max
JM
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000188:drug therapy / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000639:trends*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator