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Extracranial Carotid and Vertebral Artery Disease pp 171–185Cite as

Current Status of Carotid Endarterectomy and Carotid Stenting

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Abstract

Atherosclerotic disease of the carotid artery is a major contributor to morbidity and mortality, accounting for 10–15% of patients diagnosed with stroke. Surgical intervention of carotid artery disease with carotid endarterectomy (CEA) has been well studied and shown to reduce the risk of future ischemic stroke in patients with severe symptomatic carotid artery disease or in patients where maximal medical therapy has failed. However, the role of carotid artery stenting (CAS) has not been as clear despite being a proposed treatment option for carotid artery disease since the 1990s. A significant contribution to the lack of clarity is partly due to the large number of clinical trials that have either confirmed or refuted the use of CAS to treat patients with carotid artery stenosis. The goal of this chapter is to provide the reader an overview of the clinical trials that have led to our current conclusions about stenting or endarterectomy in patients with carotid artery stenosis.

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References

  1. Bonati LH, Ederle J, McCabe DJ, Dobson J, CAVATAS Investigators, et al. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the carotid and vertebral artery transluminal angioplasty study: long-term follow-up of a randomised trial. Lancet Neurol. 2009;8(10):908–17.

    Article  Google Scholar 

  2. North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53.

    Article  Google Scholar 

  3. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST). Lancet. 1998;351(9113):1379–87.

    Google Scholar 

  4. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Carotid Endarterectomy Trialists’ Collaboration, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361(9352):107–16.

    Article  CAS  Google Scholar 

  5. Yadav JS, Roubin GS, Iyer S, Vitek J, King P, Jordan WD, Fisher WS. Elective stenting of the extracranial carotid arteries. Circulation. 1997;95(2):376–81.

    Article  CAS  Google Scholar 

  6. Salzler GG, Farber A, Rybin DV, Doros G, Siracuse JJ, Eslami MH. The association of carotid revascularization endarterectomy versus stent trial (CREST) and centers for medicare and medicaid services carotid guideline publication on utilization and outcomes of carotid stenting among “high-risk” patients. J Vasc Surg. 2017;66(1):104–111.e1.

    Article  Google Scholar 

  7. Sidhu PS, Allan PL. Ultrasound assessment of internal carotid artery stenosis. Clin Radiol. 1997;52(9):654–8.

    Article  CAS  Google Scholar 

  8. Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. Lancet. 2001;357(9270):1729–37.

    Google Scholar 

  9. Mas JL, Chatellier G, Beyssen B, EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial. Stroke. 2004;35(1):e18–20.

    CAS  PubMed  Google Scholar 

  10. Mas JL, Arquizan C, Calvet D, Viguier A, EVA-3S Investigators, et al. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke. 2014;45(9):2750–6.

    Article  Google Scholar 

  11. Mas JL, Chatellier G, Beyssen B, Branchereau A, EVA-3S Investigators, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355(16):1660–71.

    Article  CAS  Google Scholar 

  12. Mas JL, Trinquart L, Leys D, Albucher JF, EVA-3S investigators, 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.

    Article  Google Scholar 

  13. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493–501.

    Article  CAS  Google Scholar 

  14. Gurm HS, Yadav JS, Fayad P, Katzen BT, SAPPHIRE Investigators, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358(15):1572–9.

    Article  CAS  Google Scholar 

  15. SPACE Collaborative Group, Ringleb PA, Allenberg J, Brückmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368(9543):1239–47.

    Article  Google Scholar 

  16. Eckstein HH, Ringleb P, Allenberg JR, Berger J, 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.

    Article  Google Scholar 

  17. Stingele R, Berger J, Alfke K, Eckstein HH, et al. Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol. 2008;7(3):216–22.

    Article  Google Scholar 

  18. 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  Google Scholar 

  19. Bonati LH, Dobson J, Featherstone RL, Ederle J, et al. 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.

    Article  Google Scholar 

  20. Brott TG, Hobson RW, Howard G, Roubin GS, CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.

    Article  CAS  Google Scholar 

  21. Brott TG, Howard G, Roubin GS, Meschia JF, CREST Investigators, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021–31.

    Article  CAS  Google Scholar 

  22. Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, ACT I Investigators, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374(11):1011–20.

    Article  CAS  Google Scholar 

  23. Rudarakanchana N, Dialynas M, Halliday A. Asymptomatic carotid surgery trial-2 (ACST-2): rationale for a randomised clinical trial comparing carotid endarterectomy with carotid artery stenting in patients with asymptomatic carotid artery stenosis. Eur J Vasc Endovasc Surg. 2009;38(2):239–42.

    Article  CAS  Google Scholar 

  24. ACST-2 Collaborative Group, Halliday A, Bulbulia R, Gray W, et al. Status update and interim results from the asymptomatic carotid surgery trial-2 (ACST-2). Eur J Vasc Endovasc Surg. 2013;46(5):510–8.

    Article  Google Scholar 

  25. Howard VJ, Meschia JF, Lal BK, Turan TN, CREST-2 Study Investigators, et al. Carotid revascularization and medical management for asymptomatic carotid stenosis: protocol of the CREST-2 clinical trials. Int J Stroke. 2017;12(7):770–8.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, St. John Hospital and Medical Centers, Detroit, MI, USA

    Richard D. Fessler

  2. Section of Neurosurgery, Department of Surgery, Providence-Providence Park Hospital, Southfield, MI, USA

    Justin G. Thomas

Authors
  1. Richard D. Fessler
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  2. Justin G. Thomas
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Correspondence to Richard D. Fessler .

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Editors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, USA

    Sachinder Singh Hans

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Fessler, R.D., Thomas, J.G. (2018). Current Status of Carotid Endarterectomy and Carotid Stenting. In: Hans, S. (eds) Extracranial Carotid and Vertebral Artery Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-91533-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-91533-3_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91532-6

  • Online ISBN: 978-3-319-91533-3

  • eBook Packages: MedicineMedicine (R0)

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