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Surgical Management of Extracranial Carotid Disease

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Introduction to Vascular Neurosurgery


Stroke remains one of the most common causes of death and disability among all ages. Carotid disease is a common manifestation of focal atherosclerosis most often located at the origin of the internal carotid artery. Such carotid artery disease increases a person’s risk for cerebrovascular disease and stroke. It is responsible for 15% of all ischemic stroke. With changes in lifestyle and an aging population, it is likely that the prevalence of carotid atherosclerosis is projected to rise and consequently more people will be at risk of stroke.

Sufficient evidence is now available from several clinical trials showing that carotid artery interventions, such as carotid endarterectomy (CEA) and, more recently, carotid artery stenting (CAS), can reduce the risk of stroke and its related deaths in carefully selected individuals. Both forms of revascularization are proven to be safe when performed by experienced practitioners in properly selected patients.

Major trials have not demonstrated that CAS is superior to CEA in the treatment of carotid stenosis and CEA remains the gold standard in treatment of significant carotid artery stenosis.

This chapter describes the indications for CEA and current guidelines for the interventional management of carotid stenosis, including patient assessment and surgical considerations. Finally, operative technique is described in detail.

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Correspondence to Zakaria Hakma .

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Sulaiman, M., Hakma, Z. (2022). Surgical Management of Extracranial Carotid Disease. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham.

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