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Controversies in Vascular Neurosurgery pp 147–156Cite as

Carotid Artery Stenosis: Discussion

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Abstract

Despite recent advances in the diagnosis and management, stroke remains one of the most common causes of death and the leading cause of disability in adulthood in developed countries. More than 700,000 new and recurrent strokes occur in the United States each year [1]. Carotid atherosclerotic disease is an important cause of stroke and is responsible for up to 30 % of acute cerebrovascular accidents. Effective prevention remains the best option for reducing the burden of stroke. Therapeutic options include medical treatment, carotid endarterectomy (CEA), and carotid artery stenting (CAS). To choose the appropriate treatment strategy, the risks, benefits, and costs of each option should be assessed. CEA has been established as an effective management strategy in patients with high-grade carotid stenosis and is considered the standard of care for the primary and secondary prevention of stroke related to carotid artery stenosis [2]. With technological advancements in balloon catheter and stent technology, CAS has become widely used, both in the management of symptomatic and asymptomatic patients with carotid disease. However, the debate regarding the best treatment of carotid stenosis has led to the development of a multitude of randomized controlled trials that compared the safety and efficacy of CEA and CAS and their roles in the management of carotid atherosclerotic disease. In patients undergoing CAS, the most important acute complication is related to the distal embolization of particles generated during the endovascular procedure. Another debate has emerged questioning the use of embolic protection devices (EPD) in patients treated with CAS and the role of these devices in preventing the occurrence of thromboembolic events. In this chapter, we aim to shed the light on the major clinical trials dealing with CAS and CEA and compare the safety and efficacy of these two interventions in the management of carotid stenosis.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

    Badih Daou MD

  2. Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

    Pascal Jabbour MD

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  1. Badih Daou MD
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  2. Pascal Jabbour MD
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Correspondence to Pascal Jabbour MD .

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Editors and Affiliations

  1. Neuroscience Inst. Dept. of Neurosurgery, Drexel Univ. College of Medicine, Drexel, Philadelphia, Pennsylvania, USA

    Erol Veznedaroglu

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Daou, B., Jabbour, P. (2016). Carotid Artery Stenosis: Discussion. In: Veznedaroglu, E. (eds) Controversies in Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27315-0_13

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  • DOI: https://doi.org/10.1007/978-3-319-27315-0_13

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