Worldwide CAS Practice in 2011

Journal article

Stroke prevention is a major public health priority; best medical therapy for patients who are at risk of atherosclerosis reduces their risk of stroke. In patients with tight carotid artery stenosis, the risk of subsequent stroke is significantly reduced by removing the atherosclerotic plaque. Carotid endarterectomy (CEA) has been available for more than 50 years and has, to date, been the standard treatment for significant carotid stenosis in symptomatic and asymptomatic patients. Carotid artery stenting (CAS) is a new and effective treatment that avoids the pain and morbidity associated with surgery.

A number of trials have compared CAS with CEA, and although both procedures have a real risk of perioperative stroke, recent randomized trials have highlighted an increased risk of minor stroke with CAS and an increased risk of perioperative myocardial infarction with CEA. Cranial nerve injury and access site hematoma requiring return to the operating room or an unexpected increase in the level of care are significantly greater after CEA, while contrast related issues are a consideration for CAS. Clinical trials have not yet provided clear evidence of superiority of either treatment for “standard operative risk” patients and have been criticized for their design, patient selection, and very variable physician training and credentialing.

This article describes the main messages of current guidelines for CAS from the European Society for Vascular Surgery (ESVS) (2009), the American Heart Association (AHA) (2011), and the UK National Institute for Clinical Excellence (NICE) (2011). The ESVS and the AHA guideline documents are large consensus documents covering a wide range of topics related to the management of carotid disease, whereas NICE guidelines are specific to CAS. The extracts in this article summarize the messages from these guidelines.

Authors: Halliday, A; Macdonald, S; Neequaye, S

• Publication status: Published
• Peer review status: Peer reviewed
• Journal: Endovascular Today
• Issue: September 2011
• Pages: 47-54
• Publication date: 2011-09-01