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Carotid Revascularization for Prevention of Stroke: Carotid Endarterectomy and Carotid Artery Stenting

      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.
      ACAS (Asymptomatic Carotid Atherosclerosis Study), ACST (Asymptomatic Carotid Surgery Trial), ARCHeR (ACCULINK for Revascularization of Carotids in High-Risk Patients), CABG (coronary artery bypass grafting), CAS (carotid artery stenting), CAVATAS (Carotid and Vertebral Artery Transluminal Angioplasty Study), CEA (carotid endarterectomy), CREST (Carotid Revascularization Endarterectomy vs Stent Trial), ECST (European Carotid Surgery Trial), FDA (Food and Drug Administration), MI (myocardial infarction), NASCET (North American Symptomatic Carotid Endarterectomy Trial), NIH (National Institutes of Health), NNT (number needed to treat), RCT (randomized controlled trial), SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy), SPACE (Stent-protected Percutaneous Angioplasty of the Carotid vs Endarterectomy)
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