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Int J Angiol 2015; 24(03): 223-235
DOI: 10.1055/s-0035-1558645
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Carotid Endarterectomy: Current Concepts and Practice Patterns

Sibu P. Saha
1   Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
,
Subhajit Saha
2   MediCiti Institute of Medical Science, Hyderabad, India
,
Krishna S. Vyas
1   Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
› Author Affiliations
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Publication History

Publication Date:
14 August 2015 (online)

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Abstract

Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS.

Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA.

Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS.

Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA.

Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon.

Keywords

carotid artery disease - stroke - carotid artery stenosis - atherosclerosis - carotid endarterectomy - carotid artery stents - endovascular carotid
 

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