Carotid endarterectomy (CEA) is still considered the "gold-standard" of the treatment of patients with significant carotid stenosis and has proven its value during past decades. However, endovascular techniques have recently been evolving. Carotid artery stenting (CAS) is challenging CEA for the best treatment in patients with carotid stenosis
Aspects-such as evolving best medical treatment, timely intervention, interventionalists' experience, and analysis of plaque composition-may have important influences on the future treatment of patients with carotid artery stenosis.
Aspects-such as evolving best medical treatment, timely intervention, interventionalists' experience, and analysis of plaque composition-may have important influences on the future treatment of patients with carotid artery stenosis.
Cochrane Database Syst Rev. 2012 Sep 12;9:CD000515. doi: 10.1002/14651858.CD000515.pub4.
Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Endovascular treatment is associated with an increased risk of peri-procedural stroke or death compared with endarterectomy. However, this excess risk appears to be limited to older patients. The longer term efficacy of endovascular treatment and the risk of restenosis are unclear and require further follow-up of existing trials. Further trials are needed to determine the optimal treatment for asymptomaticcarotid stenosis.
Vascular. 2009 Jul-Aug;17(4):183-9.
Carotid artery stenting may be losing the battle against carotid endarterectomy for the management of symptomatic carotid artery stenosis, but the jury is still out.
Abstract
Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The CochraneControlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were "carotid artery stenting," "carotidendarterectomy," "symptomatic carotid artery stenosis," "treatment," "clinical trial," "randomized," and "long-term results," in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomaticcarotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current "gold standard" procedure (CEA), the results of soon-to-be reported trials (CarotidRevascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.
Ann Thorac Surg. 2014 Jan;97(1):102-9. doi: 10.1016/j.athoracsur.2013.07.091. Epub 2013 Oct 1.
Meta-analysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting.
meta-analysis of observational studies suggests comparable outcomes in combined and staged approach for synchronouscarotid and coronary artery disease. Hence, the 2 strategies can be used interchangeable in the clinical practice, with each having specific applications linked to specific clinical conditions. A randomized trial is warranted to answer this question definitively
J Vasc Surg. 2008 Aug;48(2):355-360; discussion 360-1. doi: 10.1016/j.jvs.2008.03.031. Epub 2008 Jun 24.
Trends and outcomes of concurrent carotid revascularization and coronary bypass.
Timaran CH1, Rosero EB, Smith ST, Valentine RJ, Modrall JG, Clagett GP. Although CAS may currently be performed for high-risk patients, it is still infrequently used in patients who require concurrent carotidand coronary interventions. In the United States, patients who undergo CAS-CABG have significantly decreased in-hospital stroke rates compared with patients undergoing CEA-CABG but similar in-hospital mortality. CAS may provide a safer carotid revascularization option for patients who require CABG.
