Key result
Modern medical therapy challenges routine revascularization for asymptomatic carotid stenosis.
Why the study?
The optimal management strategy for symptomatic and asymptomatic carotid artery stenosis remains uncertain due to evolving treatment options and outcomes.
Does carotid endarterectomy or carotid artery stenting improve outcomes compared to best medical treatment in patients with carotid artery stenosis?
Does carotid endarterectomy or carotid artery stenting improve outcomes compared to best medical treatment in patients with carotid artery stenosis?
The review emphasizes individualized selection between CEA and CAS for symptomatic carotid stenosis and calls for re-evaluating invasive treatments for asymptomatic stenosis due to improved medical therapies.
CEA established for symptomatic moderate-or-greater stenosis; individualized CEA versus CAS selection now required.
In this review, we presented the evidence concerning carotid artery stenosis treatment in symptomatic stenosis and asymptomatic stenosis separately, and discussed the future challenges. The validity of carotid endarterectomy (CEA) to treat moderate or greater degree of symptomatic carotid artery stenosis appears to be established. Due to the additional option of carotid artery stenting (CAS), it is necessary to comprehensively determine whether CEA or CAS is more appropriate for each individual patient. Moreover, since there are rapid advancements in devices for CAS and improvements in treatment outcomes, continual learning of the latest treatment method is essential. For asymptomatic stenosis, due to improvements in the outcomes with best medical treatment (BMT), it is essential to re-evaluate the use of invasive CEA/CAS. Continual verification of the latest randomized clinical trial that compares CEA, CAS, and BMT, and establishment of a diagnostic method that can accurately extract the group of patients who have the highest future risk of developing ischemia, are desired.
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Yoshida et al. (2015) conducted a review in Carotid artery stenosis. Carotid endarterectomy (CEA) and Carotid artery stenting (CAS) vs. Best medical treatment (BMT) was evaluated. Carotid endarterectomy is established for symptomatic stenosis, while stenting is an alternative, and improved medical treatments require re-evaluating invasive options for asymptomatic cases.
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