Treatment of Carotid Stenosis: Carotid Endarterectomy and Carotid Angioplasty and Stenting

2010 ◽  
pp. 529-562
Author(s):  
Franco Nessi ◽  
Michelangelo Ferri ◽  
Emanuele Ferrero ◽  
Andrea Viazzo
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Angioplasty ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid Angioplasty and Stenting versus Carotid Endarterectomy for Treatment of Asymptomatic Carotid Stenosis: A Randomized Trial in a Community Hospital

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 318-325 ◽  
Author(s):  
William H. Brooks ◽  
Rick R. McClure ◽  
Michael R. Jones ◽  
Timothy L. Coleman ◽  
Linda Breathitt
Keyword(s):  
Randomized Trial ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Hospital Charges ◽  
Carotid Angioplasty ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Procedural Complications ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract OBJECTIVE Carotid endarterectomy (CEA) is effective in reducing the risk of stroke in individuals with more than 60% carotid stenosis. Carotid angioplasty and stenting (CAS) has been proffered as effective and used in treating individuals with asymptomatic carotid stenosis despite the absence of proven clinical equivalency. This randomized trial was designed to explore the hypothesis that CAS is equivalent to CEA for treating asymptomatic carotid stenosis. METHODS A total of 85 individuals presenting with asymptomatic carotid stenosis of more than 80% were selected randomly for CAS or CEA and followed up for 48 months. RESULTS Stenosis decreased to an average of 5% after CAS. The patency of the reconstructed artery remained satisfactory regardless of the technique, as determined by carotid ultrasonography. No major complications such as cerebral ischemia or death occurred. Procedural complications associated with CAS (n = 5) were hypotension and/or bradycardia; those concomitant with CEA (n = 3) were cervical nerve injury or complications related to general anesthesia (n = 4). Both procedures were well tolerated in the context of pain and discomfort. Hospital stay was similar in the two groups (mean, 1.1 versus 1.2 d). The occurrence of complications associated with CAS or CEA prolonged hospitalization by 3 days (mean, 4.0 versus 4.5 d). Return to full activity was achieved within 1 week by more than 85% of patients; all returned to their usual lifestyle by 2 weeks. Although hospital charges were slightly higher for CAS, costs were similar. CONCLUSION CAS and CEA may be equally effective and safe in treating individuals with asymptomatic carotid stenosis.

scholarly journals Carotid Endarterectomy: A Review

2004 ◽  
Vol 31 (1) ◽  
pp. 22-36 ◽  
Author(s):  
J. Max Findlay ◽  
B. Elaine Marchak ◽  
David M. Pelz ◽  
Thomas E. Feasby
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Case Series ◽  
Routine Practice ◽  
Complication Rates ◽  
Carotid Angioplasty ◽  
Catheter Angiography ◽  
Eversion Endarterectomy ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Background:Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults.Investigation:Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment.Indications:Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 - 69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions.Techniques:Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. “Eversion” endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis.Carotid angioplasty and stenting:Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA.Auditing:It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.

scholarly journals PS82. Carotid Endarterectomy for Treatment of In-Stent Restenosis after Carotid Angioplasty and Stenting

2011 ◽  
Vol 53 (6) ◽  
pp. 51S
Author(s):  
Boudewijn L. Reichmann ◽  
Jorinde H. van Laanen ◽  
Jean-Paul de Vries ◽  
Johanna M. Hendriks ◽  
Hence J. Verhagen ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Angioplasty ◽  
Stent Restenosis ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
In Stent Restenosis

Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S83-S91 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Akshal Patel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

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