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Treatment of Symptomatic Carotid Stenosis: Carotid Stent Placement Versus Endarterectomy

  • Cardiovascular Disease and Stroke (D Leifer and JE Safdieh, Section Editors)
  • Published:
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Abstract

The mainstay of treatment options for symptomatic carotid stenosis is focused around medical management, carotid endarterectomy, and carotid angioplasty and stent placement. The International Carotid Stenting Study (ICSS), also called Carotid and Vertebral Artery Transluminal Angioplasty Study 2 (CAVATAS 2), the Stent-Supported Percutaneous Angioplasty of the Carotid Artery Versus Endarterectomy (SPACE) trial, the Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, and the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) were five major trials which compared carotid endarterectomy and carotid angioplasty and stent placement. We review the results of the trials and incorporation of the results into clinical decision making.

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References

  1. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53.

    Article  Google Scholar 

  2. European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet. 1991;337(8752):1235–43.

    Article  Google Scholar 

  3. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379–87.

    Google Scholar 

  4. Lindblad B, Persson NH, Takolander R, Bergqvist D. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial. Stroke. 1993;24(8):1125–8.

    Article  PubMed  CAS  Google Scholar 

  5. Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65(6):794–801.

    Article  PubMed  CAS  Google Scholar 

  6. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke. 1991;22(6):711–20.

    Article  Google Scholar 

  7. Ederle J, Dobson J, Featherstone RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375(9719):985–97.

    Article  PubMed  Google Scholar 

  8. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339(20):1415–25.

    Article  PubMed  CAS  Google Scholar 

  9. Brott TG, Brown Jr RD, Meyer FB, Miller DA, Cloft HJ, Sullivan TM. Carotid revascularization for prevention of stroke: carotid endarterectomy and carotid artery stenting. Mayo Clin Proc. 2004;79(9):1197–208.

    PubMed  Google Scholar 

  10. Bonati LH, Lyrer P, Ederle J, Featherstone R, Brown MM. Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2012;9, CD000515.

    PubMed  Google Scholar 

  11. Ringleb PA, Allenberg J, Bruckmann H, et al. 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(9543):1239–47.

    Article  PubMed  CAS  Google Scholar 

  12. Cambria RP. Commentary on: 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. Perspect Vasc Surg Endovasc Ther. 2007;19(2):201–3.

  13. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493–501.

    Article  PubMed  CAS  Google Scholar 

  14. Brott TG, Hobson 2nd RW, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.

    Article  PubMed  CAS  Google Scholar 

  15. 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(3):216–22.

    Article  PubMed  Google Scholar 

  16. Yadav JS. Carotid stenting in high-risk patients: design and rationale of the SAPPHIRE trial. Cleve Clin J Med. 2004;71 Suppl 1:S45–6.

    Article  PubMed  Google Scholar 

  17. Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7(10):885–92.

    Article  PubMed  Google Scholar 

  18. Furlan AJ. Carotid-artery stenting—case open or closed? N Engl J Med. 2006;355(16):1726–9.

    Article  PubMed  CAS  Google Scholar 

  19. Qureshi AI. Carotid angioplasty and stent placement after EVA-3S trial. Stroke. 2007;38(6):1993–6.

    Article  PubMed  Google Scholar 

  20. Silver FL, Mackey A, Clark WM, et al. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011;42(3):675680.

    Article  Google Scholar 

  21. Voeks JH, Howard G, Roubin GS, et al. Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke. 2011;42(12):3484–90.

    Article  PubMed  Google Scholar 

  22. Cohen DJ, Stolker JM, Wang K, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol. 2011;58(15):1557–65.

    Article  PubMed  Google Scholar 

  23. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227–76.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Syeda L. Alqadri declares no conflict of interest.

Adnan I Qureshi declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Neurology, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39202, USA

    Syeda L. Alqadri

  2. Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA

    Adnan I. Qureshi

  3. Department of Neurology, University of Minnesota, 420 Delaware Street SE MMC 295, Minneapolis, MN, 55455, USA

    Adnan I. Qureshi

Authors
  1. Syeda L. Alqadri
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  2. Adnan I. Qureshi
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Correspondence to Adnan I. Qureshi.

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This article is part of the Topical Collection on Cardiovascular Disease and Stroke

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Alqadri, S.L., Qureshi, A.I. Treatment of Symptomatic Carotid Stenosis: Carotid Stent Placement Versus Endarterectomy. Curr Atheroscler Rep 15, 345 (2013). https://doi.org/10.1007/s11883-013-0345-5

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  • DOI: https://doi.org/10.1007/s11883-013-0345-5

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