Recent concepts in patient selection for carotid artery stenting versus endarterectomy

Abstract

There is much clinical evidence showing the benefits of surgical revascularization for carotid artery stenosis. Carotid endarterectomy(CEA) has been established as an effective therapy through randomized controlled trials(RCTs) since the 1990s,and then,carotid artery stenting(CAS) emerged as an alternative to CEA. Several RCTs examined the outcome differences between CAS and CEA,and their long-term follow-up studies have been reported. Newer RCTs that include the best contemporary medical treatments are also ongoing. In our daily practice of performing carotid revascularization,appropriate treatment modalities and devices for each patient are selected based on the patient’s background and anatomical conditions while also taking into consideration the skills of the CEA and CAS surgeons. Recent improvement in plaque imaging using MRI,CTA or ultrasonography may also lead to better prediction of future stroke risk. The purpose of this paper was to review the current concepts in selection of patients and modalities for CAS and CEA,especially focusing on the clinical evidence of RCTs,a practical method of treatment selection currently employed in our hospital and the use of state-of-the-art plaque imaging.