Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy?
Why the study?
Does intensive medical therapy, carotid endarterectomy, or carotid stenting improve outcomes in patients with symptomatic carotid artery stenosis?
Population
Patients with symptomatic carotid artery disease attributable to a significantly stenotic vessel or…
Design
Review
Authors
Discussion
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Member takes
Implication
May support medical-first approach for symptomatic carotid stenosis; leaves open need for RCTs on intracranial lesions.
Structured PICO
Does intensive medical therapy, carotid endarterectomy, or carotid stenting improve outcomes in patients with symptomatic carotid artery stenosis?
P
Population
Patients with symptomatic carotid artery disease (stroke or transient ischemic attack) attributable to a significantly stenotic vessel (70-99% or moderate 50-69% luminal narrowing) or symptomatic intracranial stenosis.
I
Intervention
Intensive medical therapy (antiplatelet/anticoagulation, high potency statin, blood pressure control, lifestyle interventions) and/or revascularization (carotid endarterectomy or carotid angioplasty and stenting).
Symptomatic carotid artery stenosis requires intensive medical therapy, with revascularization reserved primarily for extracranial lesions of 70-99% stenosis, or 50-69% stenosis if surgical risk is low.
Cite This Study
Wabnitz et al. (2017) studied this question.