Current Treatment Options in Neurology

, Volume 12, Issue 6, pp 475–482

Management of Stenosis of the Extracranial Internal Carotid Artery: Endarterectomy Versus Angioplasty and Stenting

Commentary
  • 91 Downloads

Opinion statement

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

  1. 1.
    Petty GW, Brown Jr RD, Whisnant JP, et al.: Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999, 30:2513–2516.PubMedGoogle Scholar
  2. 2.
    Gurm HS, Yadav JS, Fayad P, et al.: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008, 358:1572–1579.CrossRefPubMedGoogle Scholar
  3. 3.
    Mas JL, Chatellier G, Beyssen B, et al.: Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006, 355:1660–1671.CrossRefPubMedGoogle Scholar
  4. 4.
    SPACE Collaborative Group, Ringleb PA, Allenberg J, et al.: 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomized non-inferiority trial. Lancet 2006, 368:1239–1247.CrossRefPubMedGoogle Scholar
  5. 5.•
    Brott TG, Hobson 2nd RW, Howard G, et al.: Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010, 363:11–23.CrossRefPubMedGoogle Scholar
  6. 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. 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
  8. 8.
    Hopkins LN, Roubin GS, Chakhtoura EY, et al.: The carotid revascularization trial: credentialing of interventionalist and final results of lead-in phase. J Stroke Cerebrovasc Dis 2010, 19:153–162.CrossRefPubMedGoogle Scholar
  9. 9.
    Chiam PT, Roubin GS, Iyer SS, et al.: Carotid artery stenting in elderly patients: importance of case selection. Catheter Cardiovasc Interv 2008, 72:318–324.CrossRefPubMedGoogle Scholar
  10. 10.
    Chaturvedi S, Dumont AS: The learning curve for neuroendovascular procedures: how important is it? [editorial]. Neurology 2009, 72:1974–1975.CrossRefPubMedGoogle Scholar
  11. 11.
    Bonati LH, Jongen LM, Haller S, et al.: New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010, 9(4):353–362.CrossRefPubMedGoogle Scholar
  12. 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. 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. 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.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Neurology-Cannaday 2EMayo Clinic FloridaJacksonvilleUSA
  2. 2.Department of NeurologyMayo Clinic FloridaJacksonvilleUSA

Personalised recommendations