Carotid Artery Stenting Versus Carotid Endarterectomy: Post CREST

Abstract

The risk of stroke associated with carotid artery stenosis can be reduced with carotid endarterectomy or carotid artery stenting in carefully selected patients. While surgery has been the traditional treatment there have been many trials comparing carotid endarterectomy with carotid artery stenting, and stenting has shown promising results for certain patient populations. This article reviews the natural history of carotid artery stenosis, the data supporting carotid endarterectomy, trials directly comparing surgery to stenting, and current recommendations for each modality.

Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

“…In the United States, it is estimated that 1,350,000 CEAs were performed and 90,000 CASs were placed between 1998 and 2008 . During this same time, CAS use in the United States increased from 2.8% to 12.6% of all carotid artery revascularization procedures, due in part to the publication of several large, multicenter studies demonstrating its safe use as a less‐invasive alternative to CEA for certain patient populations …”

“…3 During this same time, CAS use in the United States increased from 2.8% to 12.6% of all carotid artery revascularization procedures, 3 due in part to the publication of several large, multicenter studies demonstrating its safe use as a lessinvasive alternative to CEA for certain patient populations. 4,5 Sonography is considered the first-line imaging modality of choice for the evaluation of iatrogenic vascular injuries. As surgical and endovascular carotid artery interventions have become increasingly common, sonologists may expect to encounter iatrogenic complications from these procedures.…”

Randomized Trials: A Quest for the Truth or a Means to an End?

“…In an ongoing attempt to substantiate the equivalency of CAS to CEA, many investigators have reviewed 15–19 and analyzed 20–25 the results from the more recent CAS vs. CEA trials, and new analyses from the CREST database are emerging at a rapid pace. 26–31 With all this data at hand, one valid view is that we have abundant information to help the clinician select the appropriate treatment for a patient with carotid artery disease based on age, gender, symptomatology, comorbidity level, and anatomy.…”