Skip to main content

Carotid artery disease: Stenting versus endarterectomy

Current Atherosclerosis Reports volume 10, pages 391–397 (2008)Cite this article

Abstract

Atherosclerotic carotid artery stenosis is a major cause of disabling stroke or death. Although carotid endarterectomy (CEA) is currently considered to be the standard of care for patients with a severe symptomatic stenosis and selected patients with an asymptomatic carotid stenosis, carotid angioplasty and stenting (CAS) is increasingly being used as an alternative treatment modality. This article briefly summarizes the current trial data on CEA and CAS. More importantly, potential risk factors for CEA and CAS are reviewed and the complementary role of these techniques in the management of the individual patient is discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1991, 325:445–453.

  2. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995, 273:1421–1428.

  3. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998, 351:1379–1387.

  4. Halliday A, Mansfield A, Marro J, et al.: Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004; 363:1491–1502.

    PubMed  Article  CAS  Google Scholar 

  5. Sacco RL, Adams R, Albers G, et al.: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 2006, 37:577–617.

    PubMed  Article  Google Scholar 

  6. Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A: New brain lesions after carotid stenting versus carotid endarterectomy. A systematic review of the literature. Stroke 2008, 39:1911–1919.

    PubMed  Article  Google Scholar 

  7. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 2001, 357:1729–1737.

  8. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006, 368:1239–1247.

  9. Brooks WH, McClure RR, Jones MR, et al.: Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 2001, 38:1589–1595.

    PubMed  Article  CAS  Google Scholar 

  10. Brooks WH, McClure RR, Jones MR, et al.: Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery. 2004, 54:318–324.

    PubMed  Article  Google Scholar 

  11. 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.

    PubMed  Article  CAS  Google Scholar 

  12. Naylor AR, Bolia A, Abbott RJ, et al.: Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 1998, 28:326–334.

    PubMed  Article  CAS  Google Scholar 

  13. Barrett KM, Brott TG: Carotid endarterectomy versus angioplasty/stenting for carotid stenosis. Curr Atheroscler Rep 2007, 9:333–340.

    PubMed  Article  Google Scholar 

  14. Ederle J, Featherstone RL, Brown MM: Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev 2007;CD000515.

  15. Ringleb PA, Chatellier G, Hacke W, et al.: Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: a meta-analysis. J Vasc Surg 2008, 47:350–355.

    PubMed  Article  Google Scholar 

  16. Rothwell PM, Gibson RJ, Slattery J, Warlow CP: Prognostic value and reproducibility of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists’ Collaborative Group. Stroke 1994, 25:2440–2444.

    PubMed  CAS  Google Scholar 

  17. Morgenstern LB, Fox AJ, Sharpe BL, et al.: The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Neurology 1997, 48:911–915.

    PubMed  CAS  Google Scholar 

  18. Rothwell PM, Warlow CP: Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists’ Collaborative Group. Stroke 2000, 31:622–630.

    PubMed  CAS  Google Scholar 

  19. Biller J, Feinberg WM, Castaldo JE, et al.: Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1998, 29:554–562.

    PubMed  CAS  Google Scholar 

  20. Abbott AL, Chambers BR, Stork JL, et al.: Embolic signals and prediction of ipsilateral stroke or transient ischemic attack in asymptomatic carotid stenosis: a multicenter prospective cohort study. Stroke 2005, 36:1128–1133.

    PubMed  Article  Google Scholar 

  21. Hartmann A, Hupp T, Koch HC, et al.: Prospective study on the complication rate of carotid surgery. Cerebrovasc Dis 1999, 9:152–156.

    PubMed  Article  CAS  Google Scholar 

  22. Sillesen H, Amarenco P, Szarek M, et al.: Atorvastatin treatment in patients with carotid stenosis is associated with a marked reduction in the risk of stroke, cardiac events and endarterectomy. A substudy of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial [abstract]. Stroke 2007, 457.

  23. Bates ER, Babb JD, Casey DE, et al.: ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). J Am Coll Cardiol 2007, 49:126–170.

    PubMed  Article  Google Scholar 

  24. Alberts MJ, for the publication committee of WALLSTENT: Results of a multicenter prospective randomized trial of carotid stenting vs. carotid endarterectomy [abstract]. Stroke 2001, 325.

  25. Yadav JS, Wholey MH, Kuntz RE, et al.: Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004, 351:1493–1501.

    PubMed  Article  CAS  Google Scholar 

  26. Roubin GS, New G, Iyer SS, et al.: Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis. A 5-year prospective analysis. Circulation 2001, 103:532–537.

    PubMed  CAS  Google Scholar 

  27. Iyer SS, White CJ, Hopkins LN, et al.: Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol 2008, 51:427–434.

    PubMed  Article  Google Scholar 

  28. Hobson RW, Brott T, Roubin GS, et al.: Closure of the lead-in phase of CREST (Carotid Revascularization Endarterectomy vs. Stenting trial): 30-day and 1 year analyses [abstract]. Stroke 2008, 38:557

    Google Scholar 

  29. Ringleb PA: 1-year results of the Stent-protected Percutaneous Angioplasty of the Carotid vs. Endarterectomy trial [abstract]. Stroke 2008, 39:686.

    Google Scholar 

  30. Verzini F, Cao P, De Rango P, et al.: Appropriateness of learning curve for carotid artery stenting: an analysis of periprocedural complications. J Vasc Surg 2006, 44:1205–1211.

    PubMed  Article  Google Scholar 

  31. Hobson RW, Howard VJ, Roubin GS, et al.: Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg 2004, 40:1106–1111.

    PubMed  Article  Google Scholar 

  32. Stingele R, Berger J, Alfke K, et al.: Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol 2008, 7:216–222.

    PubMed  Article  Google Scholar 

  33. Gray WA, Yadav JS, Verta P, et al.: The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv 2007, 70:1025–1033.

    PubMed  Article  Google Scholar 

  34. Hofmann R, Niessner A, Kypta A, et al.: Risk score for peri-interventional complications of carotid artery stenting. Stroke 2006, 37:2557–2561.

    PubMed  Article  Google Scholar 

  35. Kastrup A, Gröschel K, Schulz JB, et al.: Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid angioplasty and stenting. Stroke 2005, 36:787–791.

    PubMed  Article  Google Scholar 

  36. Stanziale SF, Marone LK, Boules TN, et al.: Carotid artery stenting in octogenarians is associated with increased adverse outcomes. J Vasc Surg 2006, 43:297–304.

    PubMed  Article  Google Scholar 

  37. Kastrup A, Gröschel K, Schnaudigel S, et al.: Target lesion ulceration and arch calcification are associated with increased incidence of carotid stenting-associated ischemic lesions in octogenarians. J Vasc Surg 2008, 47:88–95.

    PubMed  Article  Google Scholar 

  38. Lam RC, Lin SC, DeRubertis B, et al.: The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg 2007, 45:875–880.

    PubMed  Article  Google Scholar 

  39. Alvarez B, Ribo M, Maeso J, et al.: Transcervical carotid stenting with flow reversal is safe in octogenarians: a preliminary safety study. J Vasc Surg 2008, 47:96–100.

    PubMed  Article  Google Scholar 

  40. Mathur A, Roubin GS, Iyer SS, et al.: Predictors of stroke complicating carotid artery stenting. Circulation 1998, 97:1239–1245.

    PubMed  CAS  Google Scholar 

  41. Safian RD, Bresnahan JF, Jaff MR, et al.: Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol 2006, 20:2384–2389.

    Article  Google Scholar 

  42. White CJ, Iyer SS, Hopkins LN, et al.: Carotid stenting with distal protection in high surgical risk patients: the BEACH trial 30 day results. Catheter Cardiovasc Interv 2006, 67:503–512.

    PubMed  Article  Google Scholar 

  43. Naylor AR: Delay may reduce procedural risk, but at what price to the patient? Eur J Vasc Endovasc Surg 2008, 35:383–391.

    PubMed  Article  CAS  Google Scholar 

  44. Gröschel K, Knauth M, Ernemann U, et al.: Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stenting. Eur J Neurol 2008, 15:2–5.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Andreas Kastrup

Authors
  1. Andreas Kastrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonja Schnaudigel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katrin Wasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Klaus Gröschel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Kastrup.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kastrup, A., Schnaudigel, S., Wasser, K. et al. Carotid artery disease: Stenting versus endarterectomy. Curr Atheroscler Rep 10, 391–397 (2008). https://doi.org/10.1007/s11883-008-0061-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-008-0061-8

Keywords

  • Carotid Endarterectomy
  • Carotid Stenosis
  • Carotid Artery Stenting
  • Carotid Artery Stenosis
  • Asymptomatic Carotid