Should We Adopt Micro-Interintimal Dissection: A Novel and Worthwhile Advance in Carotid Surgery Technique, but Does It Prevent Restenosis and Early Neurological Deficits?

Abstract

therosclerotic cervical carotid artery disease is a significant contributor to the annual incidence of ischemic A stroke, which remains a leading cause of death, and was responsible for almost 130,000 fatalities in the United States in 2011 alone (14). A recent meta-analysis suggests that the prevalence of moderate and severe carotid stenosis (>50% luminal stenosis) is relatively common (6). Almost two decades ago, the Asymptomatic Carotid Atherosclerosis Study and the Asymptomatic Carotid Surgery Trial defined the 5-year cumulative risk of ipsilateral ischemic stroke among asymptomatic patients with more than 60% stenosis to be as high as 12% (8, 12). Among the symptomatic patient population—defined as those patients who have previously experienced a hemispheric transient ischemic attack, nondisabling stoke, or amaurosis fugax—the cumulative risk of ipsilateral ischemic stroke within 3e5 years of diagnosis was even higher, approximately 20%e25%, if the degree of luminal stenosis was greater than 70% (9, 19).