Modern advances in endovascular and surgical interventions for patients with carotid artery disease

The article provides an overview of the latest achievements in the treatment of carotid artery disease. For a long time, carotid endarterectomy (CEA) was considered the best option in the treatment of patients with this pathology. However, with the advancement of technology and widespread use of endovascular therapies carotid angioplasty with stenting (CAS) comes to replace the CEA. The largest study comparing the results of CAS with the CEA, was the CREST trial (Carotid Revascularisation Endarterectomy Versus Stenting Trial), which did not show any significant differences in the primary composite endpoint (death, myocardial infarction and stroke in a period of 30 days after procedure) during 10 years of follow up (n=2502) between the stenting group (11.8%; 95% confidence interval - CI 9.1 to 14.8) and carotid endarterectomy group (9.9%; 95% CI, 7.9 to 12.2), (hazard ratio 1.10; 95% CI 0.83 to 1.44). However, there are still many unresolved issues. One of the most important is a high frequency of "small" strokes due to intraprocedural cerebral microembolization. It is hoped by solving these issues CAS will be considered the best option in the treatment of patients with carotid artery disease.