Carotid endarterectomy (CEA) has been used for the past several decades in patients
with carotid occlusive disease. Large randomized controlled trials have documented
that CEA is a highly effective stroke preventive among patients with carotid stenosis
and recent transient ischemic attack or cerebral infarction. In asymptomatic patients
with carotid stenosis, clinical trial data suggest that the degree of stroke prevention
from CEA is less than among symptomatic patients. However, otherwise healthy men and
women with an asymptomatic carotid stenosis of 60% or greater have a lower risk of
future cerebral infarction, including disabling cerebral infarction, if treated with
CEA compared with those treated with medical management alone. More recently, carotid
artery stenting has been performed increasingly for patients with carotid occlusive
disease. As technology has improved, procedural risks have declined and are approaching
those reported for CEA. The benefits and durability of CEA compared with carotid artery
stenting are still unclear and are being studied in ongoing randomized controlled
trials.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy.AJNR Am J Neuroradiol. 1980; 1: 348-349
- Percutaneous transluminal angioplasty of the carotid artery.AJNR Am J Neuroradiol. 1986; 7: 349-358
- Extracranial carotid artery stenosis.Stroke. 2003; 34: 2767-2773
- Changing patterns in the practice of carotid endarterectomy in a large metropolitan area.JAMA. 1986; 255: 2609-2612
- Joint study of extracranial arterial occlusion, V: progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions.JAMA. 1970; 211: 1993-2003
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453
- Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis.N Engl J Med. 1998; 339: 1415-1425
- MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis.Lancet. 1991; 337: 1235-1243
- Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis.JAMA. 1991; 266: 3289-3294
- Causes and severity of ischemic stroke in patients with internal carotid artery stenosis.JAMA. 2000; 283: 1429-1436
- Variation in surgical and anaesthetic technique and associations with operative risk in the European Carotid Surgery Trial: implications for trials of ancillary techniques.Eur J Vasc Endovasc Surg. 2002; 23: 117-126
- Clinical and radiographic risk factors for operative stroke and death in the European Carotid Surgery Trial.Eur J Vasc Endovasc Surg. 2002; 23: 108-116
- Reanalysis of the final results of the European Carotid Surgery Trial.Stroke. 2003; 34: 514-523
- The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery.Neurology. 1997; 48: 911-915
- Carotid surgery in acute symptomatic patients.Eur J Vasc Endovasc Surg. 2003; 25: 60-67
- Carotid endarterectomy and prevention of stroke in the very elderly [letter].Lancet. 2001; 357: 1142-1143
- Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.Lancet. 2004; 363: 915-924
- Efficacy of carotid endarterectomy for asymptomatic carotid stenosis.N Engl J Med. 1993; 328: 221-227
- Endarterectomy for asymptomatic carotid artery stenosis.JAMA. 1995; 273: 1421-1428
- Carotid surgery versus medical therapy in asymptomatic carotid stenosis.Stroke. 1991; 22: 1229-1235
- Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.Lancet. 2004; 363: 1491-1502
- Medical compared with surgical treatment of asymptomatic carotid artery stenosis.Ann Intern Med. 1995; 123: 720-722
- Surgical results: a justification of the surgeon selection process for the ACAS trial.J Vasc Surg. 1996; 23: 323-328
- An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study.Stroke. 1996; 27: 2216-2224
- Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.Mayo Clin Proc. 1992; 67: 513-518
- Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.Med Care. 2002; 40: I35-I43
- Carotid endarterectomy in Scotland: 1981-1996.J Public Health Med. 2003; 25: 36-41
- Outcomes of carotid endarterectomy: how does the Australian state of New South Wales compare with international bench-marks?.J Vasc Surg. 2002; 36: 62-69
- Sex differences in carotid endarterectomy utilization and 30-day postoperative mortality.Neurology. 2003; 60: 471-476
- Multistate population-based outcomes of combined carotid endarterectomy and coronary artery bypass.J Vasc Surg. 2003; 37: 32-39
- Retinal embolization during carotid angioplasty and stenting: mechanisms and role of cerebral protection systems.Catheter Cardiovasc Interv. 2002; 56: 320-327
- Sex differences in carotid endarterectomy outcomes: results from the Ontario Carotid Endarterectomy Registry.Stroke. 2003; 34: 1120-1125
- Provincial carotid endarterectomy outcomes.Can J Neurol Sci. 2002; 29: 333-336
- Auditing carotid endarterectomy: a regional experience.Can J Neurol Sci. 2002; 29: 326-332
- Hospital and surgeon determinants of carotid endarterectomy outcomes.Arch Neurol. 2002; 59: 1877-1881
- Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics.JAMA. 1998; 279: 1278-1281
- Indications, outcomes, and provider volumes for carotid endarterectomy.JAMA. 1998; 279: 1282-1287
- Revisiting the appropriateness of carotid endarterectomy.Stroke. 2003; 34: 1464-1471
- Carotid endarterectomy after NASCET and ACAS: a statewide study.J Vasc Surg. 1998; 27: 1017-1022
- Carotid endarterectomy in the octogenarian: outcomes of 345 procedures performed from 1995-2000.Cardiovasc Surg. 2003; 11: 105-112
- Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial.J Vasc Surg. 1998; 28: 326-334
- The risk of vascular surgery in a metropolitan community: with observations on surgeon experience and hospital size.J Vasc Surg. 1984; 1: 13-21
- Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985-1996 update.Stroke. 1998; 29: 346-350
- Durability of carotid endarterectomy.Stroke. 2003; 34: 2941-2944
- Gender as a primary predictor of outcome after carotid endarterectomy.J Vasc Surg. 2002; 35: 748-753
- Does race predict short-term mortality after carotid surgery? the results of a meta-analysis.J Natl Med Assoc. 2002; 94: 25-30
- High-risk carotid endarterectomy: challenges for carotid stent protocols.J Vasc Surg. 2002; 35: 16-21
- Preprocedural risk stratification: identifying an appropriate population for carotid stenting.J Vasc Surg. 2001; 33: 728-732
- Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting.J Vasc Surg. 2004; 39: 958-965
- High-risk carotid endarterectomy: fact or fiction.J Vasc Surg. 2003; 37: 40-46
- Preoperative risk factors for carotid endarterectomy: defining the patient at high risk.J Vasc Surg. 2003; 37: 1191-1199
- Reoperative approaches for carotid restenosis.Semin Vasc Surg. 1994; 7: 195-200
- Recurrent stenosis after carotid endarterectomy.Surg Gynecol Obstet. 1979; 149: 360-364
- Late patency of the carotid artery after endarterectomy: problems of definition, follow-up methodology, and data analysis.J Vasc Surg. 1988; 8: 79-85
- Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results.J Vasc Surg. 2004; 39: 985-993
- The performance of endarterectomy for disease of the extracranial arteries of the head.Stroke. 1984; 15: 948-950
- The practice of carotid endarterectomy in a large metropolitan area.Stroke. 1984; 15: 950-955
- 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: 1729-1737
- The role of stents in patients with carotid disease.Rev Cardiovasc Med. Spring 2003; 4: 61-67
- Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent).Eur Radiol. 2002; 12: 2451-2456
- Angioplasty and stenting should be performed only in the setting of a clinical trial.Stroke. 2002; 33: 2519-2520
- Carotid stenting is unproven: randomization is a must.Stroke. 2002; 33: 2522-2523
- Results of a multicenter prospective randomized trial of carotid artery stenting vs. carotid endarterectomy [abstract].Stroke. 2001; 32 (Abstract 53.): 325
- Carotid stenting in high-risk patients: design and rationale of the SAPPHIRE trial.Cleve Clin J Med. 2004; 71: S45-S46
- Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.Stroke. 1998; 29: 554-562
- The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis.N Engl J Med. 2000; 342: 1693-1700
- Carotid stenting in the CREST lead-in phase: periprocedural stroke, myocardial infarction, and death rates are lower than reported for preceding stent trials [abstract].Circulation. 2003; 108 (Abstract 2748.): IV-604
- Carotid revascularization using endarterectomy or stenting systems (CARESS): phase I clinical trial.J Endovasc Ther. 2003; 10: 1021-1030
Gray WA, ARCHeR Executive Committee. The ARCHeR trials: final one year results. Presented at: American College of Cardiology Scientific Sessions; New Orleans, La; March 7, 2004.
- Gender and periprocedural stroke and death following carotid artery stenting: results from the CREST lead-in phase [abstract].Stroke. 2004; 35 (Abstract P5.): 253
- Developing embolic protection for carotid stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) [abstract].Circulation. 2003; 108 (Abstract 3124.): IV-687
- Does the stroke risk of stenting increase at older ages? thirty-day stroke-death rates in the CREST lead-in phase [abstract].Circulation. 2003; 108 (Abstract 2116.): IV-461
- Timing of cerebrovascular events in CREST lead-in patients [abstract].Stroke. 2004; 35 (Abstract P6.): 254
- Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis.Circulation. 2001; 103: 532-537
- Carotid stenting for severe radiation-induced extracranial carotid artery occlusive disease.J Endovasc Ther. 2000; 7: 36-40
- Carotid artery stenting: acute and long-term results.Curr Opin Cardiol. 2002; 17: 671-676
- Carotid artery stenting in older patients: is age a risk factor for poor outcome?.J Endovasc Ther. 2002; 9: 559-565
- Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential.J Vasc Surg. 1998; 27: 463-471
- New brain lesions at MR imaging after carotid angioplasty and stent placement.Radiology. 2002; 224: 361-365
- Focal ischemia of the brain after neuroprotected carotid artery stenting.J Am Coll Cardiol. 2003; 42: 1007-1013
- Characteristics of cerebral microembolism during carotid stenting and angioplasty alone.Arch Neurol. 2001; 58: 1410-1413
- Current concepts of mechanical cerebral protection during percutaneous carotid intervention.Vasc Med. 2003; 8: 25-32
- Carotid stenting with filter protection: correlation of ACT values with angiographic and histopathologic findings.J Neuroradiol. 2003; 30: 103-108
- Multicenter evaluation of carotid artery stenting with a filter protection system.J Am Coll Cardiol. 2002; 39: 841-846
- Impact of cerebral protection devices on early outcome of carotid stenting.J Endovasc Ther. 2002; 9: 786-792
- Neurological outcomes after carotid stenting protected with the NeuroShield filter compared to unprotected stenting.J Endovasc Ther. 2002; 9: 777-785
- Benefits of cerebral protection during carotid stenting with the PercuSurge GuardWire system: midterm results.J Endovasc Ther. 2002; 9: 1-13
- Differential gene expression in vascular smooth muscle cells in primary atherosclerosis and in stent stenosis in humans.Arterioscler Thromb Vasc Biol. 2002; 22: 2030-2036
- Acute-phase response after stent implantation in the carotid artery: association with 6-month in-stent restenosis.Radiology. 2003; 227: 516-521
- Histopathological findings in a human carotid artery after stent implantation: case report.J Neurosurg. 2003; 98: 199-204
- Restenosis after carotid angioplasty and stenting: a follow-up study with duplex ultrasonography.Eur J Vasc Endovasc Surg. 2003; 26: 141-144
- Operative management of carotid artery in-stent restenosis: first experiences and duplex follow-up.Eur J Vasc Endovasc Surg. 2003; 26: 137-140
- In-stent restenosis after carotid angioplasty-stenting: incidence and management.J Vasc Surg. 2001; 33: 220-225
- Determinants of in-stent restenosis after carotid angioplasty: a case-control study.J Endovasc Ther. 2003; 10: 1031-1038
Article Info
Footnotes
Individual reprints of this article are not available. The entire Symposium on Cerebrovascular Diseases will be available for purchase as a bound booklet from the Proceedings Editorial Office at a later date.
Identification
Copyright
© 2004 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
