Carotid Artery Stenting Versus Endarterectomy for Atherosclerosis: An Evidence-Based Review

  • Robert K. Townsend
  • Kyle M. Fargen
  • Jasmeet Singh
  • John A. Wilson
  • Stacey Q. Wolfe


Carotid endarterectomy (CEA) and carotid angioplasty and stenting are widely performed revascularization procedures for the prevention of future stroke secondary to moderate to severe atherosclerotic carotid artery disease. Both procedures have been the focus of numerous prospective trials that have aimed to explore the safety and efficacy of these techniques. In this chapter we explore the methods and results of these trials. We provide current recommendations for treatment of carotid atherosclerotic disease based on the most recent trial evidence.


Angioplasty Atherosclerosis Carotid artery Endarterectomy Stenosis Stent Stroke 


  1. 1.
    Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–54.CrossRefGoogle Scholar
  2. 2.
    Estol CJ. Dr C. Miller Fisher and the history of carotid artery disease. Stroke. 1996;27(3):559–66.CrossRefGoogle Scholar
  3. 3.
    Fisher M. Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatry. 1951;65(3):346–77.CrossRefGoogle Scholar
  4. 4.
    Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;267(6846):994–6.CrossRefGoogle Scholar
  5. 5.
    DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up. JAMA. 1975;233(10):1083–5.CrossRefGoogle Scholar
  6. 6.
    Bauer RB, Meyer JS, Fields WS, Remington R, Macdonald MC, Callen P. Joint study of extracranial arterial occlusion. 3. Progress report of controlled study of long-term survival in patients with and without operation. JAMA. 1969;208(3):509–18.CrossRefGoogle Scholar
  7. 7.
    Busuttil RW, Baker JD, Davidson RK, Machleder HI. Carotid artery stenosis – hemodynamic significance and clinical course. JAMA. 1981;245(14):1438–41.CrossRefGoogle Scholar
  8. 8.
    Kartchner MM, McRae LP. Noninvasive evaluation and management of the asymptomatic carotid bruit. Surgery. 1977;82(6):840–7.Google Scholar
  9. 9.
    Pokras R, Dyken ML. Dramatic changes in the performance of endarterectomy for diseases of the extracranial arteries of the head. Stroke. 1988;19(10):1289–90.CrossRefGoogle Scholar
  10. 10.
    Easton JD, Sherman DG. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke. 1977;8(5):565–8.CrossRefGoogle Scholar
  11. 11.
    Committee NS. NASCET: North American Symptomatic Carotid Endarterectomy Trial. Stroke. 1991;22(6):711–20.CrossRefGoogle Scholar
  12. 12.
    ACAS. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273(18):1421–8.CrossRefGoogle Scholar
  13. 13.
    Farrell B, Fraser A, Sandercock P, Slattery J, Warlow C. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379–87.CrossRefGoogle Scholar
  14. 14.
    Mathias K. A new catheter system for percutaneous transluminal angioplasty (PTA) of carotid artery stenoses. Fortschr Med. 1977;95(15):1007–11.PubMedGoogle Scholar
  15. 15.
    Diethrich EB, Marx P, Wrasper R, Reid DB. Percutaneous techniques for endoluminal carotid interventions. J Endovasc Surg. 1996;3(2):182–202.CrossRefGoogle Scholar
  16. 16.
    Jordan WD, Voellinger DC, Fisher WS, Redden D, McDowell HA. A comparison of carotid angioplasty with stenting versus endarterectomy with regional anesthesia. J Vasc Surg. 1998;28(3):397. -402-3CrossRefGoogle Scholar
  17. 17.
    Theron J, Courtheoux P, Alachkar F, Bouvard G, Maiza D. New triple coaxial catheter system for carotid angioplasty with cerebral protection. AJNR Am J Neuroradiol. 1990;11(5):869–74; discussion–7.PubMedGoogle Scholar
  18. 18.
    Brown MM, Rogers J, Bland J. Endovascular versus surgical treatment in patients with carotid stenosis in t... Lancet. 2001;357:1729–1737.Google Scholar
  19. 19.
    Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7(10):893–902.CrossRefGoogle Scholar
  20. 20.
    Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7(10):885–92.CrossRefGoogle Scholar
  21. 21.
    Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493–501.CrossRefGoogle Scholar
  22. 22.
    Clark WM, Brooks W, Mackey A, et al. Stenting verus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.CrossRefGoogle Scholar
  23. 23.
    Ederle J, Dobson J, Featherstone RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375(9719):985–97.CrossRefGoogle Scholar
  24. 24.
    Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374(11):1011–20.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Robert K. Townsend
    • 1
  • Kyle M. Fargen
    • 2
  • Jasmeet Singh
    • 3
    • 4
  • John A. Wilson
    • 5
  • Stacey Q. Wolfe
    • 5
  1. 1.Department of Neurological SurgeryWake Forest UniversityWinston-SalemUSA
  2. 2.Department of Neurological SurgeryWake Forest University, Wake Forest Baptist HealthWinston-SalemUSA
  3. 3.Department of Radiology and NeurosurgeryWake Forest University, Wake Forest Baptist HealthWinston-SalemUSA
  4. 4.Bowman Gray CenterWinston-SalemUSA
  5. 5.Department of Neurological SurgeryWake Forest University, Bowman Gray CenterWinston-SalemUSA

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