Symptomatic carotid stenosis: is stenting as safe and effective as carotid endarterectomy?
PURPOSE OF REVIEW:
Reviewing current evidence on carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) in the prevention of ipsilateral stroke in patients with a symptomatic carotid stenosis.
Randomized clinical trials and registries have consistently shown that CAS is associated with a higher risk of procedural stroke or death and a lower risk of procedural myocardial infarction and local complications compared with CEA. Both procedures are equally effective to prevent late recurrent ipsilateral stroke and are associated with similar low risk of restenosis.Individual patient data analyses of the Carotid Stenosis Trialists’ Collaboration recently showed that CAS is as safe and as effective in patients younger than 70.
Although CEA remains the standard treatment in patients with recently symptomatic carotid stenosis, CAS is a safe and effective alternative option in patients younger than 70 and can be also considered when a contraindication to CEA exists.