title: Carotid endarterectomy: still the standard of care for carotid bifurcation disease.
abstract: Current treatment guidelines of symptomatic and asymptomatic carotid stenosis are based on studies performed over a decade ago. Since that time, significant advances have been made in medical management, namely high dose statin therapy and improved antiplatelet agents, and in carotid interventions, namely the advent of carotid artery stenting. Especially with carotid stenting, the technology has grown by leaps and bounds and continues to advance at a rapid pace. These advances have necessitated new studies to compare these treatments with the gold standard of carotid endarterectomy. In asymptomatic patients, the current data does not justify medical management alone for severe (>80%) carotid stenosis. Furthermore, in both asymptomatic and symptomatic patients current studies have failed to demonstrate equivalence of CAS to CEA for significant carotid stenosis. Clearly additional studies comparing CAS, CEA, and medical management are needed to further clarify this issue. In the future, advances in CAS technology and techniques may greatly expand the role of CAS beyond its current role in certain high-risk patient subsets. However, for the time being CEA still remains the gold standard for carotid intervention.
authors: New York University Medical School, USA. Caron.rockman@nyumc.org
authors: Caron
authors: C
authors: Rockman
authors: Shang
authors: S
authors: Loh
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D059039:Standard of Care / Q000191:economics; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome