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Online ISSN 1827-1847
CAROTID ANGIOPLASTY AND OTHER CEREBROVASCULAR INTERVENTIONS
Lieb M. 1, Hines G. 2
1 Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA;
2 Division of Vascular Surgery, Winthrop University Hospital, Mineola, NY, USA
The current guidelines for the treatment of symptomatic atherosclerotic carotid artery disease are based on large clinical trials dating back to the early 1980’s. These trials showed a clear benefit to surgery over the best medical therapy at the time. Similarly, clinical trials to determine the best treatment for asymptomatic atherosclerotic carotid artery disease showed a benefit to surgical therapy over best available medical therapy; however, the therapeutic window in favor of surgery was much smaller in the asymptomatic population. The best medical therapy available at the time of these large clinical trials was aspirin alone. Since that time there have been significant advancements in medical therapy for patients with atherosclerotic disease. This has led many to question the benefit of surgery over the current best available medical therapy for carotid atherosclerotic disease, especially in the asymptomatic population. There are currently trials ongoing in an attempt to re-evaluate the benefit of surgical therapy over medical therapy for atherosclerotic carotid artery disease. Here we review the published literature to evaluate the current best medical therapy available in the preoperative, intraoperative, and post-operative periods for patients undergoing carotid intervention. Research has shown that these therapies not only reduce the stroke rate, but also reduce the overall number of cardiac events in patients with atherosclerotic disease. Therefore, all patients with atherosclerotic disease would benefit from these therapies whether they are undergoing surgical intervention or not.