Skip to main content

Extracranial Carotid Stenosis

  • Chapter
  • First Online:
  • 894 Accesses

Abstract

Carotid endarterectomy (CEA) is the method of choice for treatment of asymptomatic and symptomatic carotid stenoses. Carotid artery stenting (CAS) may be considered as an alternative to CEA in high-volume centres with documented death or stroke rate <3% in asymptomatic patients, and <6% in symptomatic patients, respectively. Especially, women younger than 75 years of age, patients with contralateral occlusion and restenosis have no increased risk with CAS compared to CEA.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Abbott AL, Paraskevas KI, Kakkos SK, et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke. 2015;46:3288–301.

    Article  PubMed  Google Scholar 

  • AbuRahma AF, Stone PA, Srivastava M, Hass SM, Mousa AY, Dean LS, Campbell JE, Chong BY. The effect of surgeon’s specialty and volume on the perioperative outcome of carotid endarterectomy. J Vasc Surg. 2013;58:666–72.

    Article  PubMed  Google Scholar 

  • Al-Damluji MS, Dharmarajan K, Zhang W, Geary LL, Stilp E, Dardik A, Mena-Hurtado C, Curtis JP. Readmissions after carotid artery revascularization in the Medicare population. J Am Coll Cardiol. 2015;65:1398–408.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bekelis K, Bakhoum SF, Desai A, Mackenzie TA, Goodney P, Labropoulos N. A risk factor-based predictive model of outcomes in carotid endarterectomy: the National Surgical Quality Improvement Program 2005-2010. Stroke. 2013;44:1085–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bennett KM, Scarborough JE, Cox MW, Shortell CK. The impact of intraoperative shunting on early neurologic outcomes after carotid endarterectomy. J Vasc Surg. 2015;61:96–102.

    Article  PubMed  Google Scholar 

  • Bensley RP, Yoshida S, Lo RC, Fokkema M, Hamdan AD, Wyers MC, Chaikof EL, Schermerhorn ML. Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting. J Vasc Surg. 2013;58:412–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bonati LH, Lyrer P, Ederle J, Featherstone R, Brown MM. Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2012;(9):CD000515.

    Google Scholar 

  • Bonati LH, Dobson J, Featherstone RL, et al.; International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385(9967):529–38

    Google Scholar 

  • Brothers TE, Ricotta 2nd JJ, Gillespie DL, Geraghty PJ, Kenwood CT, Siami FS, Ricotta JJ, White RA. Contemporary results of carotid endarterectomy in “normal-risk” patients from the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2015;62:923–8.

    Article  PubMed  Google Scholar 

  • Brott TG, Hobson RW 2nd, Howard G, et al.; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.

    Google Scholar 

  • Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ ACCF/ AHA/ AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation. 2011;124:489–532.

    Article  PubMed  Google Scholar 

  • Brott TG, Howard G, Roubin GS, et al.; CREST Investigators. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374:1021–31.

    Google Scholar 

  • Calvet D, Mas JL, Algra A, et al.; Carotid Stenting Trialists’ Collaboration. Carotid stenting: is there an operator effect? A pooled analysis from the carotid stenting trialists’ collaboration. Stroke. 2014;45:527–32.

    Google Scholar 

  • International Carotid Stenting Study Investigators, 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.

    Article  PubMed Central  Google Scholar 

  • Eslami MH, Rybin DV, Doros G, Farber A. The association of publication of center for Medicaid and Medicare services guidelines for carotid artery angioplasty and stenting (CAS) and CREST results on the utilization of CAS in carotid revascularization. Ann Vasc Surg. 2015;29:1606–13.

    Article  PubMed  Google Scholar 

  • Featherstone RL, Dobson J, Ederle J, Doig D, Bonati LH, Morris S, Patel NV, Brown MM. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis. Health Technol Assess. 2016;20:1–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fokkema M, Bensley RP, Lo RC, Hamden AD, Wyers MC, Moll FL, de Borst GJ, Schermerhorn ML. In-hospital versus postdischarge adverse events following carotid endarterectomy. J Vasc Surg. 2013;57:1568–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fokkema M, de Borst GJ, Nolan BW, Lo RC, Cambria RA, Powell RJ, Moll FL, Schermerhorn ML. Carotid stenting versus endarterectomy in patients undergoing reintervention after prior carotid endarterectomy. J Vasc Surg. 2014;59:8–15.

    Article  PubMed  Google Scholar 

  • Gopaldas RR, Chu D, Dao TK, Huh J, LeMaire SA, Lin P, Coselli JS, Bakaeen FG. Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting: analysis of 10-year nationwide outcomes. Ann Thorac Surg. 2011;91:1323–9.

    Article  PubMed  Google Scholar 

  • Gupta PK, Ramanan B, Mactaggart JN, Sundaram A, Fang X, Gupta H, Johanning JM, Pipinos II. Risk index for predicting perioperative stroke, myocardial infarction, or death risk in asymptomatic patients undergoing carotid endarterectomy. J Vasc Surg. 2013;57:318–26.

    Article  PubMed  Google Scholar 

  • Huibers A, Calvet D, Kennedy F, Czuriga-Kovács KR, Featherstone RL, Moll FL, Brown MM, Richards T, de Borst GJ. Mechanism of procedural stroke following carotid endarterectomy or carotid artery stenting within the International Carotid Stenting Study (ICSS) randomised trial. Eur J Vasc Endovasc Surg. 2015;50:281–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hynes BG, Kennedy KF, Ruggiero 2nd NJ, Kiernan TJ, Margey RJ, Rosenfield K, Garasic JM. Carotid artery stenting for recurrent carotid artery restenosis after previous ipsilateral carotid artery endarterectomy or stenting: a report from the national cardiovascular data registry. JACC Cardiovasc Interv. 2014;7:180–6.

    Article  PubMed  Google Scholar 

  • Intercollegiate Stroke Working Party. National clinical guideline for stroke. 4th ed. London: Royal College of Physicians; 2012.

    Google Scholar 

  • Jalbert JJ, Nguyen LL, Gerhard-Herman MD, et al. Outcomes after carotid artery stenting in Medicare beneficiaries, 2005 to 2009. JAMA Neurol. 2015;72:276–86.

    Article  PubMed  Google Scholar 

  • Jim J, Dillavou ED, Upchurch GRJ, Osborne NH, Kenwood CT, Siami FS, White RA, Ricotta 2nd JJ, SVS Outcomes Committee. Gender-specific 30-day outcomes after carotid endarterectomy and carotid artery stenting in the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;59:742–8.

    Article  PubMed  Google Scholar 

  • Jonsson M, Gillgren P, Wanhainen A, Acosta S, Lindström D. Peri-procedural risk with urgent carotid artery stenting: a population based Swedvasc Study. Eur J Vasc Endovasc Surg. 2015;49:506–12.

    Article  CAS  PubMed  Google Scholar 

  • Jonsson M, Lindström D, Gillgren P, Wanhainen A, Malmstedt J. Long-term outcome after carotid artery stenting: a population-based matched cohort study. Stroke. 2016;47:2083–9.

    Article  PubMed  Google Scholar 

  • Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236.

    Article  PubMed  Google Scholar 

  • Kumamaru H, Jalbert JJ, Nguyen LL, Gerhard-Herman MD, Williams LA, Chen CY, Seeger JD, Liu J, Franklin JM, Setoguchi S. Surgeon case volume and 30-day mortality after carotid endarterectomy among contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting. Stroke. 2015;46:1288–94.

    Article  PubMed  Google Scholar 

  • LeFevre ML, U.S. Preventive Services Task Force. Screening for asymptomatic carotid artery stenosis: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2014;161:356–62.

    Article  PubMed  Google Scholar 

  • Loftus IM, Paraskevas KI, Johal A, Waton S, Heikkila K, Naylor AR, Cromwell DA. Delays to surgery and procedural risks following carotid endarterectomy in the UK National Vascular Registry. Eur J Vasc Endovasc Surg. 2016;52:438–43.

    Article  CAS  PubMed  Google Scholar 

  • Malas M, Glebova NO, Hughes SE, Voeks JH, Qazi U, Moore WS, Lal BK, Howard G, Llinas R, Brott TG. Effect of patching on reducing restenosis in the carotid revascularization endarterectomy versus stenting trial. Stroke. 2015;46:757–61.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mas JL, Chatellier G, Beyssen B, et al.; EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–71.

    Google Scholar 

  • Mas JL, Arquizan C, Calvet D, et al.; EVA-3S Investigators. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke. 2014;45:2750–6.

    Google Scholar 

  • McDonald RJ, McDonald JS, Therneau TM, Lanzino G, Kallmes DF, Cloft HJ. Comparative effectiveness of carotid revascularization therapies: evidence from a national hospital discharge database. Stroke. 2014;45:3311–9.

    Article  CAS  PubMed  Google Scholar 

  • Modrall JG, Chung J, Kirkwood ML, Baig MS, Tsai SX, Timaran CH, Valentine RJ, Rosero EB. Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions. J Vasc Surg. 2014;60:70–6.

    Article  PubMed  Google Scholar 

  • Paraskevas KI, Kalmykov EL, Naylor AR. Stroke/death rates following carotid artery stenting and carotid endarterectomy in contemporary administrative dataset registries: a systematic review. Eur J Vasc Endovasc Surg. 2016;51:3–12.

    Article  CAS  PubMed  Google Scholar 

  • Radak D, Tanaskovic S, Sagic D, Antonic Z, Babic S, Popov P, Matic P, Rancic Z. Carotid angioplasty and stenting is safe and effective for treatment of recurrent stenosis after eversion endarterectomy. J Vasc Surg. 2014;60:645–51.

    Article  PubMed  Google Scholar 

  • Raman G, Kitsios GD, Moorthy D, Hadar N, Dahabreh IJ, O’Donnell TF, Thaler DE, Feldmann E, Lau J. Management of asymptomatic carotid stenosis [Internet]. Rockville: Agency for Healthcare Research and Quality (US); 2012. AHRQ Technology Assessments.

    Google Scholar 

  • Rantner B, Schmidauer C, Knoflach M, Fraedrich G. Very urgent carotid endarterectomy does not increase the procedural risk. Eur J Vasc Endovasc Surg. 2015;49:129–36.

    Article  CAS  PubMed  Google Scholar 

  • Rathenborg LK, Venermo M, Troëng T, Jensen LP, Vikatmaa P, Wahlgren C, Ijäs P, Björck M, Kragsterman B. Editor’s Choice – Safety of carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke: a case-controlled multicentre registry study. Eur J Vasc Endovasc Surg. 2014;48:620–5.

    Article  CAS  PubMed  Google Scholar 

  • Schermerhorn ML, Fokkema M, Goodney P, Dillavou ED, Jim J, Kenwood CT, Siami FS, White RA, SVS Outcomes Committee. The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry. J Vasc Surg. 2013;57:1318–24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schneider JR, Helenowski IB, Jackson CR, Verta MJ, Zamor KC, Patel NH, Kim S, Hoel AW, Society for Vascular Surgery Vascular Quality Initiative and the Mid-America Vascular Study Group. A comparison of results with eversion versus conventional carotid endarterectomy from the Vascular Quality Initiative and the Mid-America Vascular Study Group. J Vasc Surg. 2015;61:1216–22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sharma V, Deo SV, Park SJ, Joyce LD. Meta-analysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting. Ann Thorac Surg. 2014;97:102–9.

    Article  PubMed  Google Scholar 

  • Sharpe R, Sayers RD, London NJ, Bown MJ, McCarthy MJ, Nasim A, Davies RS, Naylor AR. Procedural risk following carotid endarterectomy in the hyperacute period after onset of symptoms. Eur J Vasc Endovasc Surg. 2013;46:519–24.

    Article  CAS  PubMed  Google Scholar 

  • Strömberg S, Gelin J, Osterberg T, Bergström GM, Karlström L, Osterberg K, Swedish Vascular Registry (Swedvasc) Steering Committee. Very urgent carotid endarterectomy confers increased procedural risk. Stroke. 2012;43:1331–5.

    Article  PubMed  Google Scholar 

  • Strömberg S, Nordanstig A, Bentzel T, Österberg K, Bergström GM. Risk of early recurrent stroke in symptomatic carotid stenosis. Eur J Vasc Endovasc Surg. 2015;49:137–44.

    Article  PubMed  Google Scholar 

  • European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, et al.; ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.

    Google Scholar 

  • Timaran CH, Mantese VA, Malas M, Brown OW, Lal BK, Moore WS, Voeks JH, Brott TG, CREST Investigators. Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg. 2013;57:303–8.

    Article  PubMed  Google Scholar 

  • Tsantilas P, Kühnl A, Kallmayer M, Knappich C, Schmid S, Kuetchou A, Zimmermann A, Eckstein HH. Stroke risk in the early period after carotid related symptoms: a systematic review. J Cardiovasc Surg. 2015;56:845–52.

    CAS  Google Scholar 

  • Tu J, Wang S, Huo Z, Wu R, Yao C, Wang S. Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: systematic review and meta-analysis. Surgery. 2015;157:1166–73.

    Article  PubMed  Google Scholar 

  • Vaniyapong T, Chongruksut W, Rerkasem K. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2013;(4):CD000126.

    Google Scholar 

  • Villwock MR, Singla A, Padalino DJ, Deshaies EM. Stenting versus endarterectomy and the impact of ultra-early revascularization for emergent admissions of carotid artery stenosis. J Stroke Cerebrovasc Dis. 2014a;23:2341–9.

    Article  PubMed  Google Scholar 

  • Villwock MR, Singla A, Padalino DJ, Ramaswamy R, Deshaies EM. Optimum timing of revascularization for emergent admissions of carotid artery stenosis with infarction. Clin Neurol Neurosurg. 2014b;127:128–33.

    Article  PubMed  Google Scholar 

  • Villwock MR, Padalino DJ, Deshaies EM. Carotid artery stenosis with acute ischemic stroke: stenting versus angioplasty. J Vasc Interv Neurol. 2015;8:11–6.

    PubMed  PubMed Central  Google Scholar 

  • Wallaert JB, Cronenwett JL, Bertges DJ, Schanzer A, Nolan BW, De Martino R, Eldrup-Jorgensen J, Goodney PP, Vascular Study Group of New England. Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival. J Vasc Surg. 2013;58:112–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wallaert JB, Nolan BW, Stone DH, Powell RJ, Brown JR, Cronenwett JL, Goodney PP. Physician specialty and variation in carotid revascularization technique selected for Medicare patients. J Vasc Surg. 2016a;63:89–97.

    Article  PubMed  Google Scholar 

  • Wallaert JB, Newhall KA, Suckow BD, Brooke BS, Zhang M, Farber AE, Likosky D, Goodney PP, Vascular Quality Initiative. Relationships between 2-year survival, costs, and outcomes following carotid endarterectomy in asymptomatic patients in the Vascular Quality Initiative. Ann Vasc Surg. 2016b;35:174–82.

    Article  PubMed  Google Scholar 

  • Werner N, Zeymer U, Hochadel M, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Fifteen-year experience with carotid artery stenting (from the carotid artery stenting-registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte). Am J Cardiol. 2015;115:360.

    Article  PubMed  Google Scholar 

  • Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167:2417–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Debus, E.S., Grundmann, R.T. (2017). Extracranial Carotid Stenosis. In: Evidence-based Therapy in Vascular Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47148-8_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47148-8_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47147-1

  • Online ISBN: 978-3-319-47148-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics