Carotid Endarterectomy versus Endovascular Stent Placement as Therapy for Symptomatic Carotid Artery Disease

Stroke-related morbidity and mortality remain unacceptably high. Recent estimates suggest that it accounts for approximately one out of every 17 deaths in the US, with one death from the direct consequences of stroke every three to four minutes. Of the almost 800,000 strokes that occur annually, 87% are ischaemic, the remainder occurring predominantly as a consequence of intracerebral haemorrhage. The accessibility of the extracranial internal carotid artery to revascularisation, together with the strong correlation between the severity of carotid artery stenosis and the further risk of stroke in patients who have already experienced a transient ischaemic attack (TIA) or stroke (up to 35% at five years in one series), has driven the field of carotid endarterectomy (CEA) and carotid artery stenting (CAS). In this article we will discuss the merits and risks of both of these revascularisation methods for patients with symptomatic extracranial carotid artery disease.