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Publication:

Surgical Technology International XX - Cardiovascular Surgery

Article title:

Carotid Endarterectomy: Current Consensus and Controversies

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Author(s)

Robbert Meerwaldt, MD, PhD
Consultant Surgeon
Department of Surgery, Medical Spectrum Twente
Enschede, The Netherlands

 

Linda Hermus, MD
Resident, General Surgery
Department of Surgery, Division of Vascular Surgery
University Medical Center Groningen
Groningen, The Netherlands

 

Michel M.P.J. Reijnen, MD, PhD
Consultant Vascular Surgeon Department of Surgery
Alysis Zorggroep
Rijnstate, Arnhem, The Netherlands

 

Clark J. Zeebregts MD, PhD
Consultant Vascular Surgeon, Department of Surgery,
Division of Vascular Surgery University Medical Center Groningen
Groningen, The Netherlands

Abstract

Stroke is the third most common cause of mortality, and carotid artery stenosis causes 8% to 29% of all ischemic strokes. Best medical treatment forms the basis of carotid stenosis treatment, and carotid endarterectomy (CEA) has an additional beneficial effect in high-grade stenosis. Carotid angioplasty and stenting (CAS) has challenged CEA as a primary carotid intervention. At present, CEA remains the gold standard, but in the future, CAS techniques will evolve and might become beneficial for subgroups of patients with carotid stenosis. This chapter briefly describes the history of carotid interventions and current consensus and controversies in CEA.
In the last two years, several meta-analyses were published on a variety of aspects of best medical treatment, CEA, and CAS. It is still a matter of debate as to whether asymptomatic patients with carotid stenosis should undergo a carotid intervention. Especially because medical treatment has dramatically evolved since the early carotid trials. On the other hand, it is clear that carotid interventions in symptomatic patients with a high-grade stenosis should be performed as early as possible after the initial neurological event in order to achieve optimal stroke risk reduction.
In CEA, the use of patching is advocated above primary closure, while the role of selective patching is still unclear. No differences in stroke and mortality rates are observed for routine versus selective shunting, for conventional versus eversion CEA, or for local versus general anesthesia.
It is anticipated that in the future, there will be several interesting developments in carotid interventions such as plaque morphology analysis, acute interventions during stroke in progress, and further evolvement of CAS techniques.