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2015 ; 24
(3
): 223-35
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Carotid Endarterectomy: Current Concepts and Practice Patterns
#MMPMID26417192
Saha SP
; Saha S
; Vyas KS
Int J Angiol
2015[Sep]; 24
(3
): 223-35
PMID26417192
show ga
Background?Stroke is the number one cause of disability and third leading cause
of death among adults in the United States. A major cause of stroke is carotid
artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have
varying results regarding the equivalence and perioperative complication rates of
stents versus carotid endarterectomy (CEA) in the management of CAS.
Objectives?We review the evidence for the current management of CAS and describe
the current concepts and practice patterns of CEA. Methods?A literature search
was conducted using PubMed to identify relevant studies regarding CEA and
stenting for the management of CAS. Results?The introduction of CAS has led to a
decrease in the percentage of CEA and an increase in the number of CAS procedures
performed in the context of all revascularization procedures. However, the
efficacy of stents in patients with symptomatic CAS remains unclear because of
varying results among randomized trials, but the perioperative complication rates
exceed those found after CEA. Conclusions?Vascular surgeons are uniquely
positioned to treat carotid artery disease through medical therapy, CEA, and
stenting. Although data from randomized trials differ, it is important for
surgeons to make clinical decisions based on the patient. We believe that CAS can
be adopted with low complication rate in a selected subgroup of patients, but CEA
should remain the standard of care. This current evidence should be incorporated
into practice of the modern vascular surgeon.