CardioVascular and Interventional Radiology

, Volume 35, Issue 2, pp 225–233

A Surgeon’s View on Endarterectomy and Stenting in 2011: Lest We Forget, It’s All About Preventing Stroke

Review

DOI: 10.1007/s00270-011-0282-z

Cite this article as:
Naylor, A.R. Cardiovasc Intervent Radiol (2012) 35: 225. doi:10.1007/s00270-011-0282-z

Abstract

It has been nearly 60 years since Felix Eastcott published his seminal paper on carotid reconstruction, which paved the way for carotid endarterectomy (CEA) and then carotid artery stenting (CAS) to assume prominent roles in the prevention of stroke. Yet the ensuing 60 years has witnessed repeated cycles of challenges to practice, professional mistrust, conflicts of interest, dogmatic retention of traditional management strategies, inappropriate corporate interventions, and a general failure to adapt to new evidence. Even the performance of large-scale randomised trials has been associated with rancour and a lack of consensus. This article reviews the history of invasive interventions in the treatment of carotid disease and makes a plea to both the surgical and interventional communities that the fundamental priority must always be the prevention of stroke. It concludes with an appeal for colleagues to collaborate to determine how best to treat patients during the hyperacute period after the onset of symptoms and to identify a smaller cohort of asymptomatic patients who are truly at high risk for stroke in whom to target CAS or CEA.

Keywords

Stenting Stent graft Carotid artery Neurointerventions Stroke therapy Brain Neurological Nervous system Carotid endarterectomy 

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  1. 1.Vascular Surgery Group, Division of Cardiovascular SciencesLeicester Royal InfirmaryLeicesterUK

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