Carotid Artery Disease: Then and Now

Key Words: carotid endarterectomy carotid stenting Editorials stroke prevention transcarotid revascularization I nterventions for carotid revascularization have been pioneered over the past 70 years, and safety for those interventions has been achieved (Figure ). Concurrently, drugs to prevent and treat atherosclerosis have been invented with improving safety, tolerability, and efficacy.The plummeting use of cigarettes and other cultural changes have complemented interventional and medical treatments, culminating in a decreasing burden from carotid disease and stroke.This overview focuses on those medical and interventional treatments.Optimal management for patients with high-grade asymptomatic carotid stenosis remains to be defined. MEDICAL TREATMENTSThe safety and efficacy of medical treatment without revascularization have not been tested this century in a randomized clinical trial (RCT) focused on patients with high-grade carotid stenosis.Only 113 patients were in the medical group in the SPACE-2 (Stent-Supported Percutaneous Angioplasty of the Carotid Artery Versus Endarterectomy-2) trial. 1 The most recent comprehensive guideline statement recommends lowdose aspirin, antihypertensive treatment for patients with hypertension, lipid-lowering therapy with statins, ezetimibe, and PCSK-9 (proprotein convertase subtilisin/kexin type 9) inhibitors, as needed, and optimal