title: The indications of carotid artery stenting in symptomatic patients may need to be reconsidered.
abstract: According to the 2011 and the 2014 updated American Heart Association/American Stroke Association Guidelines, carotid artery stenting (CAS) is indicated as an alternative to carotid endarterectomy (CEA) for the management of symptomatic carotid patients. According to these recommendations, CAS is preferred to CEA in symptomatic patients with specific technical, anatomic, or physiological characteristics that render these individuals at "high risk" for surgery (e.g., contralateral carotid occlusion, previous neck irradiation, recurrent carotid stenosis, and so forth). This article presents emerging data suggesting that most of these criteria do not comprise contraindications for CEA. In fact, CEA is associated with similar (or even better) outcomes compared with CAS in many such "high-risk" patients. Based on these results, the indications of CAS in symptomatic patients may need to be reconsidered.
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK. Electronic address: paraskevask@hotmail.com.
authors.forename: Kosmas I
authors.initials: KI
authors.lastname: Paraskevas
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY; Division of Vascular Surgery, The Cleveland Clinic, Cleveland, OH.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
mesh_terms: D017130:Angioplasty / Q000295:instrumentation* / Q000401:mortality / Q000592:standards; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000075202:Contraindications; D016894:Endarterectomy, Carotid / Q000401:mortality / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome