Current Management of Extracranial Carotid Occlusive Disease

Abstract

A T A A w a l u troke continues to be a major public health concern, with ore than 750,000 strokes occurring per year in the nited States, making it the third most common cause of eath and the leading neurologic cause of longterm disabilty. The majority of strokes are ischemic in nature, and up o 20% of ischemic strokes are a result of carotid artery therosclerotic disease. Treatment of carotid artery stenosis s aimed at preventing ischemic events caused by emboliation of components of the atherosclerotic plaque, and ess commonly, by hemodynamic compromise secondary o progression to occlusion of a previously narrowed but atent internal carotid artery. Management of carotid occlusive disease continues to volve today. Carotid endarterectomy (CEA), first introuced in the 1950s, was established as the gold standard for reatment of carotid stenosis by several landmark trials in he 1990s. More recently, carotid angioplasty and stentng (CAS) emerged as a minimally invasive alternative, and everal trials ensued to determine its safety and efficacy, and he indications for its use. Although CAS has proved feasile and relatively safe, the appropriate clinical setting for its referential use over CEA remains unclear and continues to e the subject of many ongoing clinical trials. The purpose f this article is to review the literature on treatment of arotid occlusive disease, and to attempt to elucidate the urrent status of CAS and its proper place and indication in he therapeutic management of stroke associated with caotid artery stenosis.