Carotid Endarterectomy: Still the Standard of Care for Carotid Bifurcation Disease

Current treatment guidelines of symptomatic and asymptomatic carotid stenosis are based on studies performed over a decade ago. Since that time, significant advances have been made in medical management, namely high dose statin therapy and improved antiplatelet agents, and in carotid interventions,...

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Bibliographic Details
Published in:Seminars in vascular surgery 2011-03, Vol.24 (1), p.10-20
Main Authors: Rockman, Caron, MD, Loh, Shang, MD
Format: Article
Language:English
Subjects:
Angioplasty - adverse effects
Angioplasty - economics
Angioplasty - instrumentation
Asymptomatic Diseases
Carotid Stenosis - complications
Carotid Stenosis - diagnosis
Carotid Stenosis - economics
Carotid Stenosis - surgery
Carotid Stenosis - therapy
Cost-Benefit Analysis
Endarterectomy, Carotid - adverse effects
Endarterectomy, Carotid - economics
Evidence-Based Medicine
Health Care Costs
Humans
Patient Selection
Practice Guidelines as Topic
Quality of Life
Severity of Illness Index
Standard of Care - economics
Stents
Stroke - etiology
Stroke - therapy
Surgery
Treatment Outcome
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Summary:Current treatment guidelines of symptomatic and asymptomatic carotid stenosis are based on studies performed over a decade ago. Since that time, significant advances have been made in medical management, namely high dose statin therapy and improved antiplatelet agents, and in carotid interventions, namely the advent of carotid artery stenting. Especially with carotid stenting, the technology has grown by leaps and bounds and continues to advance at a rapid pace. These advances have necessitated new studies to compare these treatments with the gold standard of carotid endarterectomy. In asymptomatic patients, the current data does not justify medical management alone for severe (>80%) carotid stenosis. Furthermore, in both asymptomatic and symptomatic patients current studies have failed to demonstrate equivalence of CAS to CEA for significant carotid stenosis. Clearly additional studies comparing CAS, CEA, and medical management are needed to further clarify this issue. In the future, advances in CAS technology and techniques may greatly expand the role of CAS beyond its current role in certain high-risk patient subsets. However, for the time being CEA still remains the gold standard for carotid intervention.
ISSN:0895-7967
1558-4518
DOI:10.1053/j.semvascsurg.2011.03.005