Treatment of high-grade symptomatic carotid stenosis via carotid endarterectomy has been shown to be superior to medical management alone in several studies. Carotid angioplasty and stenting (CAS) has emerged as an alternative approach to endarterectomy to reduce the associated perioperative risks. Several anatomic and physiologic factors that increase the risk of stroke and/or death associated with endarterectomy have been identified. The alternative approach of CAS has been found to be noninferior to endarterectomy for high surgical risk patients with severe symptomatic carotid stenosis and the use of this procedure is supported by the current widely accepted guidelines. In patients with standard surgical risk, the differential benefit of CAS compared with endarterectomy is not clear. Several advantages of CAS have been identified in previous studies in selected patients. The results of CAS will undoubtedly continue to improve with advances in device designs, technological expertise, and appropriate patient selection.
Bibliographical noteFunding Information:
AHA American Heart Association, ASA American Stroke Association, ASITN American Society of Interventional and Therapeutic Neuroradiology, ASN American Society of Neuroradiology, CAS carotid angioplasty and stenting, CMS Centers for Medicare and Medicaid Services, FDA US Food and Drug Administration, IDE Investigational Device Exemption, SIR Society for Interventional Radiology Disclosure Dr. Adnan Qureshi has received funding from US National Institutes of Health RO-1-NS44976-01A2 (medication provided by ESP Pharma), American Heart Association Established Investigator Award 0840053N, and Minnesota Medical Foundation, Minneapolis, Minnesota. No other potential conflicts of interest relevant to this article were reported.
Copyright 2011 Elsevier B.V., All rights reserved.
- Carotid Angioplasty and Stenting
- Carotid Endarterectomy
- Extracranial carotid artery disease or Carotid artery stenosis