Stroke is a major health catastrophe that is responsible for the third most common cause of death and the leading cause of disability.
Carotid artery stenosis is an important cause of
brain infarctions and the risk of
stroke is directly related to the severity of
carotid artery stenosis and to the presence of symptoms. Familiarity with different methods of measuring degrees of
carotid artery stenosis is a key in understanding the role of revascularization of this disorder.
Carotid endarterectomy (CEA), surgical removal of the carotid
atherosclerotic plaque, is intended to prevent
stroke in patients with
carotid artery stenosis and currently the most commonly performed vascular procedure in the United States. Several randomized clinical trials had demonstrated the benefits of CEA in selected groups of patients with symptomatic and asymptomatic
carotid artery stenosis. However, CEA can cause
stroke, the very thing it intended to prevent, and is associated with significant perioperative complications such as those related to
general anesthesia, cardiac or nerve injury. Moreover, several anatomical and medical conditions may limit candidates for CEA. Carotid artery stenting (CS) is an evolving and less invasive technique for carotid artery revascularization. Recent studies demonstrated that CS with
embolic protection devices has become an alternative to CEA for high-surgical-risk patients and the procedure of choice for
stenoses inaccessible by surgery. The role of CS in low risk patients awaits the completion of several ongoing studies.