Abstract
The role of carotid stenting and endarterectomy has been evolving over the past few decades. Results of recent randomized trials have added more insights to the indications of the two established interventions for symptomatic moderate to severe stenosis as well as asymptomatic carotid stenosis. Despite a wide range of complication rates in various trials for both symptomatic and asymptomatic carotid stenosis, benefits of the two interventions have been consistently demonstrated for symptomatic moderate stenosis as well as asymptomatic severe stenosis albeit with lower benefit margin for asymptomatic disease. Intervention for asymptomatic carotid stenosis should only be considered when the complication rate can be maintained below 3%.
Highlights
IntroductionThe role of surgical carotid endarterectomy or endovascular stenting for carotid stenosis has been vigorously studied in multiple randomized trials over the past few decades
Despite a wide range of complication rates in various trials for both symptomatic and asymptomatic carotid stenosis, benefits of the two interventions have been consistently demonstrated for symptomatic moderate stenosis as well as asymptomatic severe stenosis albeit with lower benefit margin for asymptomatic disease
Intervention for asymptomatic carotid stenosis should only be considered when the complication rate can be maintained below 3%
Summary
The role of surgical carotid endarterectomy or endovascular stenting for carotid stenosis has been vigorously studied in multiple randomized trials over the past few decades. Results of the recently completed Second Asymptomatic Carotid Atherosclerosis Study (ACST-2) study have shed more light in the management of carotid stenosis [1]. This article represents a point of view from a neutral neurosurgeon who performs both surgery and endovascular treatment for carotid disease
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