Carotid Artery Stenosis – Endarterectomy or Stenting?

Czech version

Authors: V. Beneš ¹; D. Netuka ¹; F. Charvát ²; M. Mohapl ¹; F. Kramář ¹; S. Ostrý ¹; J. Mašková ²; J. Lacman ²
Authors‘ workplace: Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha ¹; Radiodiagnostické oddělení ÚVN Praha ²
Published in: Cesk Slov Neurol N 2008; 71/104(4): 388-399
Category: Minimonography

Podpořeno IGA MZCR NR/9435-3.

Overview

In past years, carotid artery stenting (CAS) has been receiving much attention in the treatment of carotid stenosis. CAS is spreading fast and, both scientific and lay communities are under the impression that CAS will soon replace carotid endarterectomy (CEA). Treatment of carotid artery stenosis by both CEA and CAS is not difficult, but it must be performed as an institutional programme and requires teamwork. We feel it is appropriate to summarise the current state of affairs in the form of review. The studies comparing CEA and medical treatment will be summarized first along with the American Heart Association (AHA) recommendations. The randomized studies comparing CEA and CAS will be summarised. Based on published data the authors conclude that CAS is an alternative method to be used in specific situations. The definitive conclusions can be postulated only after the ongoing trials comparing CEA and CAS are concluded and published. Apart from specific situations, CAS should not be indicated outside the ongoing trials and registries. In conclusion; CEA is the treatment of choice for patients with carotid stenosis, provided AHA recommendations are followed. CAS is used in the following specific conditions: 1. carotid re-stenosis, 2. dissections, 3. significant tandem lesions, 4. post-irradiation stenosis and in patients after major neck surgeries, 5. in patients with complex anatomical conditions.

Key words:
carotid artery stenosis – endarterectomy – stenting

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