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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2004 March;48(1):1-9

language: English

Evidence-based surgical treatment of carotid stenosis. Literature review

Andaluz N. 1, Zuccarello M. 1,2

1 Department of Neurosurgery The Neuroscience Institute University of Cincinnati, College of Medicine Cincinnati, OH, USA
2 Mayfield Clinic, Cincinnati, OH, USA


Carotid sten­o­sis is an impor­tant ­cause of tran­sient ischem­ic ­attacks and ­stroke. The ­cause of carot­id sten­o­sis is ­most ­often ath­ero­scler­o­sis, ­which ­accounts for 10% to 20% of ­brain infarc­tion cas­es. Despite the intro­duc­tion of tis­sue-plas­mi­no­gen acti­va­tor and oth­er prom­is­ing experi­men­tal ther­a­pies for ­select ­patients ­with ­acute ischem­ic ­stroke pre­ven­tion ­remains the ­best ­approach to ­reduce its ­impact. Stroke-­prone ­patients can be iden­ti­fied and tar­get­ed for spe­cif­ic inter­ven­tions. At ­this junc­ture, treat­ment of carot­id sten­o­sis is a ­well-estab­lished ther­a­peu­tic tar­get and a pil­lar of ­stroke pre­ven­tion. Two ­main strat­e­gies ­exist for the treat­ment of carot­id sten­o­sis. The 1st is sta­bil­iza­tion or halt­ing the pro­gres­sion of the carot­id ­plaque for­ma­tion ­with med­i­ca­tions and mod­ifi­ca­tions of ­risk fac­tors (e.g., hyper­ten­sion, dia­betes, smok­ing, obes­ity, ­high cho­les­te­rol). The 2nd ­approach is the elim­i­na­tion or reduc­tion of carot­id sten­o­sis by carot­id endar­te­rec­to­my or angio­plas­ty and stent­ing. Carotid endar­te­rec­to­my is the main­stay of ther­a­py for symp­to­mat­ic, ­severe carot­id sten­o­sis. Although its ­role for asymp­to­mat­ic ­patients ­appears ­more lim­it­ed, it is dis­tinct for ­severe sten­o­sis. Carotid angio­plas­ty and stent­ing are tech­niques in mat­u­ra­tion ­with the attrac­tive­ness of ­being ­less inva­sive ­that ­face the chal­lenge of at ­least rep­li­cat­ing the ­results of sur­gery. In ­this arti­cle, we ­will dis­cuss the sur­gi­cal man­age­ment of symp­to­mat­ic and asymp­to­mat­ic carot­id sten­o­sis ­based on the evi­dence pro­vid­ed by the lit­er­a­ture.

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