Home > Journals > Journal of Neurosurgical Sciences > Past Issues > Journal of Neurosurgical Sciences 2021 June;65(3) > Journal of Neurosurgical Sciences 2021 June;65(3):322-6

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe PROMO
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

REVIEW  NEUROSURGICAL MANAGEMENT AND INTERVENTION OF ISCHEMIC STROKE 

Journal of Neurosurgical Sciences 2021 June;65(3):322-6

DOI: 10.23736/S0390-5616.20.05207-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Carotid artery revascularization: endarterectomy versus endovascular therapy

Soliman H. OUSHY 1, Muhammed A. ESSIBAYI 1, Luis E. SAVASTANO 1, Giuseppe LANZINO 1, 2

1 Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA; 2 Department of Radiology, Mayo Clinic, Rochester, MN, USA



Carotid endarterectomy is considered the gold standard for primary and secondary stroke prevention in patients with asymptomatic and symptomatic carotid artery stenosis. The role of CEA has been defined by multiple randomized multicenter trials and CEA is the most studied surgical procedure. In recent years, with advances in endovascular techniques, carotid angioplasty, and stenting (CAS) has been proposed as an alternative to CEA especially in high-risk patients. In this article, we review some of the most important trials on the invasive treatment of carotid artery stenosis and summarized the most recent treatment recommendations based on current evidence. The data overwhelmingly supports revascularization of patients with symptomatic stenosis between 70-90%, with a clear preference for CEA over CAS to be done within 14 days of symptom onset is possible. However, CAS is an acceptable alternative to CEA in certain symptomatic patients such as those with severe medical comorbidities, high riding plaques, contralateral occlusion, restenosis after prior CEA, and radiation-induced stenosis. Treatment of asymptomatic patients remains controversial because of advanced of modern medical therapy and large trials are underway to define the role of invasive revascularization in these patients.


KEY WORDS: Endarterectomy, carotid; Carotid stenosis; Angioplasty

top of page