Carotid Revascularization in the Modern Era: A Comparative Review of Carotid Endarterectomy, Carotid Angioplasty and Stenting, and Transcarotid Artery Revascularization

Carotid artery stenosis is a major cause of acute ischemic stroke, accounting for approximately 15% of cases. Although optimal medical therapy remains the cornerstone of management, current guidelines recommend consideration of surgical intervention for symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥70% stenosis. Extensive evidence supports carotid endarterectomy (CEA) as the gold standard procedure, whereas transfemoral carotid angioplasty and stenting (TF-CAS) and transcarotid artery revascularization (TCAR) offer safe alternatives for patients with high surgical risk. Emerging data suggest that TCAR provides safety and efficacy profiles comparable to CEA and superior to TF-CAS in select patients. Considering these findings, selecting an appropriate revascularization strategy should rely on a multidisciplinary, individualized risk–benefit assessment. This article aims to provide a comparative review of the latest evidence on clinical indications, surgical techniques, and outcomes for current carotid revascularization strategies.