Key result
Carotid endarterectomy is preferred over carotid angioplasty and stenting for symptomatic carotid artery stenosis of 70-90%, though stenting is an acceptable alternative in high-risk patients.
Why the study?
Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy, warranting a review of key trials and updated treatment recommendations.
Does carotid artery revascularization prevent stroke in patients with carotid artery stenosis?
Does carotid artery revascularization prevent stroke in patients with carotid artery stenosis?
Carotid endarterectomy remains the preferred revascularization strategy for symptomatic carotid stenosis (70-90%), while carotid angioplasty and stenting is an acceptable alternative in high-risk patients.
May support endarterectomy preference in symptomatic stenosis; leaves open need for updated RCTs in high-risk subgroups.
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.
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Oushy et al. (2021) conducted a review in Carotid artery stenosis. Carotid endarterectomy (CEA) vs. Carotid angioplasty and stenting (CAS) was evaluated. Carotid endarterectomy is preferred over carotid angioplasty and stenting for symptomatic carotid artery stenosis of 70-90%, though stenting is an acceptable alternative in high-risk patients.
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