Translational Stroke Research

, Volume 10, Issue 5, pp 460–474 | Cite as

Management of De Novo Carotid Stenosis and Postintervention Restenosis—Carotid Endarterectomy Versus Carotid Artery Stenting—a Review of Literature

  • Runqi Wangqin
  • Paul R. Krafft
  • Keaton Piper
  • Jay Kumar
  • Kaya Xu
  • Maxim Mokin
  • Zeguang RenEmail author
Review Article


The current literature indicates carotid endarterectomy (CEA) as the preferred treatment for symptomatic, moderate to severe carotid artery stenosis. However, recommendations for the management of acute tandem stenosis and complete occlusion, as well as postintervention restenosis of the carotid artery, remain controversial. Here, we review the literature evaluating these conditions and provide suggestions for clinical decision-making. Acute tandem stenosis or occlusion of the common and internal carotid arteries may be treated with angioplasty alone, reserving carotid artery stenting (CAS) or CEA for severe and complex cases. Patients who underwent CEA and developed ipsilateral restenosis may be subjected to angioplasty followed by CAS, which carries a lower risk of cranial nerve injury and subsequent restenosis of the artery. For post-CAS restenosis, current evidence recommends angioplasty and CAS for the management of moderate stenosis and CEA for severe stenosis of the carotid artery. Given the lack of level 1 evidence for the management of these conditions, the abovementioned recommendations may assist clinical decision-making; however, each case and its unique risks and benefits need to be assessed individually. Future studies evaluating and defining the risks and benefits of specific treatment strategies, such as CEA and CAS, in patients with acute tandem stenosis, occlusion, and postintervention restenosis of the carotid artery need to be conducted.


Carotid artery stenosis Restenosis Endarterectomy Carotid artery stenting 


Compliance with Ethical Standards

Conflict of Interest

Runqi Wangqin, Paul R. Krafft, Keaton Piper, Jay Kumar, and Kaya Xu declare that they have no conflict of interest. Maxim Mokin serves as consultant for Cerebrotech and Imperative Care. Zeguang Ren serves as consultant for Penumbra, Inc.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyDuke University Medical CenterDurhamUSA
  2. 2.Department of Neurological SurgeryUniversity of South FloridaTampaUSA
  3. 3.Department of Neurosurgerythe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
  4. 4.Center for Cerebrovascular DiseasesShiyan Taihe HospitalShiyanChina

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