Management of Stenosis of the Extracranial Internal Carotid Artery: Endarterectomy Versus Angioplasty and Stenting
- First Online:
- 91 Downloads
Recent randomized clinical trial data support the safety and efficacy of carotid artery stenting and carotid endarterectomy for treatment of symptomatic and asymptomatic carotid occlusive disease. Endarterectomy is more effective in preventing stroke, but this may be countered by a higher risk of perioperative myocardial infarction. Age is an important determinant in selecting patients for either carotid endarterectomy or stenting. Patients older than 70 years achieve better outcomes with endarterectomy, and younger patients achieve better outcomes with stenting. Comparative clinical and anatomic durability of endarterectomy and stenting will require additional follow-up from recently completed trials. The efficacy of carotid revascularization compared with modern medical therapy in asymptomatic patients remains an important and unanswered clinical question.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.•International Carotid Stenting Study Investigators, Ederle J, Dobson J, et al.: Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet 2010, 375:985–997.CrossRefPubMedGoogle Scholar
- 7.Ederle J, Bonati LH, Dobson J, et al.: Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomized trial. Lancet Neurol 2009, 8:898–907.CrossRefPubMedGoogle Scholar
- 12.Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Lancet 2001, 357:1729–1737.Google Scholar
- 13.Bonati LH, Ederle J, McCabe DJ, et al.: Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomized trial. Lancet Neurol 2009, 8:908–917.CrossRefPubMedGoogle Scholar
- 14.US Department of Health and Human Services: Centers for Medicare and Medicaid Services. NCD for Percutaneous Transluminal Angioplasty (PTA) (20.7) [Version 9], 2010. Available at http://www.cms.gov/mcd/viewncd.asp?ncd_id=20.7&ncd_version=9&basket=ncd%3A20%2E7%3A9%3APercutaneous+Transluminal+Angioplasty+%28PTA%29. Accessed June 14, 2010.