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Carotid Artery Disease and Stenting: Insights From Recent Clinical Trials

  • Cerebrovascular Disease and Stroke
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Cerebrovascular disease remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Approximately 80% of strokes are ischemic in origin, with 20% to 25% due to atherosclerotic disease of the carotid artery. It is well established that untreated, symptomatic carotid stenosis confers a 25% risk of stroke within 2 years, and that asymptomatic carotid stenosis > 60% is associated with an 11% stroke risk at 5 years. Over the past six decades, surgical revascularization with carotid endarterectomy, when performed by experienced surgeons, has been demonstrated to be effective in reducing stroke risk in patients with severe stenosis. During the same time, medical therapy has improved considerably, and endovascular therapy with carotid angioplasty and stenting has emerged as an important alternative strategy that may play a significant role in reducing the risk of stroke in patients with carotid disease. In this review, we examine the current evidence regarding optimal medical therapy, endarterectomy, and stenting for the management of patients with carotid stenosis. Armed with these data, we may tailor our approach to optimize care based on patient- and lesion-specific considerations.

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Ronan Margey reports no potential conflict of interest relevant to this article. Douglas E. Drachman reports no potential conflict of interest relevant to this article.

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  1. Cardiology Division, Section of Vascular Medicine, Massachusetts General Hospital and Harvard Medical School, Gray-Bigelow 800, 55 Fruit Street, Boston, MA, 02114, USA

    Ronan Margey MB MRCPI & Douglas E. Drachman MD

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Correspondence to Douglas E. Drachman MD.

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Margey, R., Drachman, D.E. Carotid Artery Disease and Stenting: Insights From Recent Clinical Trials. Curr Treat Options Cardio Med 13, 129–145 (2011). https://doi.org/10.1007/s11936-011-0116-y

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