Stroke is a major cause of mortality and morbidity in the western world. Atherosclerotic disease
of the carotid arteries is in approximately 25% of the cases responsible for the cerebral
infarction.1 Since NASCET and ECST, carotid endarterectomy (CEA) is considered the standard
treatment for severe atherosclerotic carotid obstructive disease in symptomatic patients.2, 3
Similar landmark studies were performed for asymptomatic carotid artery disease.4, 5 On the
basis of these trials the American Heart Association has recommended CEA for symptomatic
patients with stenosis of 50% to 99% if the perioperative risk of stroke or death is <6%.6 In
asymptomatic patients CEA is recommended for a stenosis of 60% to 99% if the perioperative
of stroke or death is < 3%.
In an effort to minimise interventions, in the last decade carotid artery stenting (CAS) has
been suggested as an alternative to surgical endarterectomy for patients with symptomatic
and asymptomatic extra cranial obstructive disease. Initially, percutaneous transluminal balloon
angioplasty (PTA) was used. Later stent placement was introduced and has been used with
or without initial PTA. Current data on CAS and CEA suggest that CAS is quickly gaining ground
on CEA as a first-line treatment
The advantages of CAS include avoidance of general anaesthesia, an incision in the neck
and the risk of cranial and cutaneous nerve damage from the dissection. Surgically inaccessible
lesion can be treated with CAS and both procedure- and admission times are usually shorter
than for surgery, therefore reducing some cost. On the other hand, devices used for CAS are
more expensive.
At this moment many interventionists embrace carotid stenting, in particular for patients
with obvious contraindications for surgical endarterectomy like high cardiopulmonary risk,
high cervical lesion or “hostile neck”.
CAS is relatively new compared to CEA and it should be acknowledged that CAS is an evolving
technique and dedicated materials became only available recently.Wednesday, February 15, 2012
Carotid Artery Stenting and Endarterectomy: a clinical evaluation Hendriks, J.M. 2011-01-26 Doctoral Thesis Surgery
Stroke is a major cause of mortality and morbidity in the western world. Atherosclerotic disease
of the carotid arteries is in approximately 25% of the cases responsible for the cerebral
infarction.1 Since NASCET and ECST, carotid endarterectomy (CEA) is considered the standard
treatment for severe atherosclerotic carotid obstructive disease in symptomatic patients.2, 3
Similar landmark studies were performed for asymptomatic carotid artery disease.4, 5 On the
basis of these trials the American Heart Association has recommended CEA for symptomatic
patients with stenosis of 50% to 99% if the perioperative risk of stroke or death is <6%.6 In
asymptomatic patients CEA is recommended for a stenosis of 60% to 99% if the perioperative
of stroke or death is < 3%.
In an effort to minimise interventions, in the last decade carotid artery stenting (CAS) has
been suggested as an alternative to surgical endarterectomy for patients with symptomatic
and asymptomatic extra cranial obstructive disease. Initially, percutaneous transluminal balloon
angioplasty (PTA) was used. Later stent placement was introduced and has been used with
or without initial PTA. Current data on CAS and CEA suggest that CAS is quickly gaining ground
on CEA as a first-line treatment
The advantages of CAS include avoidance of general anaesthesia, an incision in the neck
and the risk of cranial and cutaneous nerve damage from the dissection. Surgically inaccessible
lesion can be treated with CAS and both procedure- and admission times are usually shorter
than for surgery, therefore reducing some cost. On the other hand, devices used for CAS are
more expensive.
At this moment many interventionists embrace carotid stenting, in particular for patients
with obvious contraindications for surgical endarterectomy like high cardiopulmonary risk,
high cervical lesion or “hostile neck”.
CAS is relatively new compared to CEA and it should be acknowledged that CAS is an evolving
technique and dedicated materials became only available recently.
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