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Treatment of Carotid Artery Disease: Endarterectomy or Angioplasty?

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Abstract

The management of carotid stenosis has enjoyed renewed interest in the neurological community in recent years due to the advent of endovascular approaches. In concert, progress in medical treatment of these patients has rekindled the debate regarding the best management of carotid stenosis overall, both for symptomatic and asymptomatic disease. For symptomatic carotid stenosis, the major decision required is choosing the type of intervention best suited for individual patients: carotid endarterectomy versus carotid artery stenting. For patients with asymptomatic carotid stenosis, intensive medical management has evolved significantly over the past decade to decrease the risk of ischemic stroke to match surgical intervention under most circumstances. This review will examine the supporting evidence for each intervention, and discuss the recent advances in medical and endovascular therapy that provide the data for a new era in clinical decision making.

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Abbreviations

ACAS:

Asymptomatic Carotid Atherosclerosis Study

ACST:

Asymptomatic Carotid Surgery Trial

CAVATAS:

Carotid and Vertebral Artery Transluminal Angioplasty Study

COSS:

Carotid Occlusion Surgery Study

CREST:

Carotid Revascularization Endarterectomy Versus Stenting Trial

ECST:

European Carotid Surgery Trial

EVA-3S:

Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis

ICSS:

International Carotid Stenting Study

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

SAPPHIRE:

Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy

SPACE:

Stent Protected-Angioplasty Versus Carotid Endarterectomy

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA

    Randolph S. Marshall

  2. Neurology Department, North Shore – LIJ Health System, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA

    Adrian Marchidann

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  1. Adrian Marchidann
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Correspondence to Randolph S. Marshall.

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Marchidann, A., Marshall, R.S. Treatment of Carotid Artery Disease: Endarterectomy or Angioplasty?. Curr Neurol Neurosci Rep 11, 61–66 (2011). https://doi.org/10.1007/s11910-010-0153-z

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