Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer.1,2 Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs. By the year 2050, an estimated 1 million persons will suffer from stroke every year due to changes in age and ethnic distribution.3 Approximately 25% of these ischemic events are related to occlusive disease of the cervical internal carotid artery.4 Carotid atherovascular stenosis increases the risk of ischemic stroke by acting as an embolic source and/or causing hypoperfusion of the ipsilateral cerebral hemisphere. Carotid endarterectomy (CEA), first performed by DeBakey in 1953,5 involves arteriotomy of the cervical carotid artery with subsequent removal of athersclerotic plaque. This procedure has been shown to substantially reduce the risk of stroke associated with high-grade carotid stenosis.6-8 During the last few years, carotid angioplasty and stenting (CAS) has evolved as an alternative to CEA, particularly in patients who are known to have a higher complication rate with CEA.9,10 The aim of this paper is to briefly review the indications and limitations of CEA, and show how CAS could be a safe and viable alternative in the management of high-risk CEA candidates.
- Carotid artery disease
- High-risk patients