Indian Journal of Neurosurgery 2013; 02(01): 009-017
DOI: 10.4103/2277-9167.110206
Controversies in Neurosurgery: Surgeon’s Perspective
Thieme Medical and Scientific Publishers Private Ltd.

Carotid endarterectomy: The procedure of choice for carotid stenosis

B.V. Savitr Sastri
,
Paritosh Pandey
1   National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

Abstract

Ischemic stroke is the commonest cause of neurological morbidity and mortality. Carotid endarterectomy has been shown to be beneficial in preventing ischemic strokes in patients with significant stenosis of the carotid artery, both in symptomatic and asymptomatic patients. Carotid artery stenting has been proposed as an alternative to CEA for this population. This paper reviews the available literature on carotid endarterectomy comparing it to the best medical therapy and carotid artery stenting in the prevention of ischemic strokes in patients with carotid stenosis. The use of newer imaging techniques and tools to redefine the existing idea of “asymptomatic” stenosis and post procedural strokes has also been reviewed. We present a concise review of existing data that shows unequivocally that endarterectomy still remains superior to stenting and best medical therapy as of now.

 
  • References

  • 1 Bonita R. Epidemiology of stroke. Lancet 1992; 339: 342-344
  • 2 Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM. et al Heart disease and stroke statistics-2011 update: A report from the American Heart Association. Circulation 2011; 123: e18-e20
  • 3 Das SK, Banerjee TK, Biswas A, Roy T, Raut DK, Mukherjee CS. et al A prospective community-based study of stroke in Kolkata, India. Stroke 2007; 38: 906-910
  • 4 Dalal PM, Malik S, Bhattacharjee M, Trivedi ND, Vairale J, Bhat P. et al Population-based stroke survey in Mumbai, India: Incidence and 28-day case fatality. Neuroepidemiology 2008; 31: 254-261
  • 5 Bamford J, Dennis M, Sandercock P, Burn J, Warlow C. The frequency, causes and timing of death within 30 days of a first stroke: The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry 1990; 53: 824-829
  • 6 Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L. Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 1989; 91: 311-321
  • 7 Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: A systematic review and meta-analysis. Stroke 2011; 42: 1489-1494
  • 8 Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet 1954; 267: 994-996
  • 9 DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up. JAMA 1975; 233: 1083-1085
  • 10 Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D. et al General anaesthesia versus local anaesthesia for carotid surgery (GALA): A multicentre, randomised controlled trial. Lancet 2008; 372: 2132-2142
  • 11 Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915-924
  • 12 Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2009:CD000190.
  • 13 Rerkasem K, Rothwell PM. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev 2010:CD000071.
  • 14 Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB. et al Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis, North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339: 1415-1425
  • 15 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351: 1379-1387
  • 16 Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA. et al Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis, Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA 1991; 266: 3289-3294
  • 17 Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1991; 325: 445-453
  • 18 Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR. et al Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107-116
  • 19 Rothwell PM, Gutnikov SA, Warlow CP. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 2003; 34: 514-523
  • 20 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273: 1421-1428
  • 21 Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J. et al Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomised controlled trial. Lancet 2004; 363: 1491-1502
  • 22 Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J. et al 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial. Lancet 2010; 376: 1074-1084
  • 23 Hobson 2nd RW, Weiss DG, Fields WS, Goldstone J, Moore WS, Towne JB. et al Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993; 328: 221-227
  • 24 Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev 2005:CD001923.
  • 25 Marquardt L, Geraghty OC, Mehta Z, Rothwell PM. Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: A prospective, population-based study. Stroke 2010; 41: e11-e17
  • 26 MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebocontrolled trial. Lancet 2002; 360: 7-22
  • 27 Reiff T, Stingele R, Eckstein HH, Fraedrich G, Jansen O, Mudra H. et al Stent-protected angioplasty in asymptomatic carotid artery stenosis vs endarterectomy: SPACE2-a three-arm randomised-controlled clinical trial. Int J Stroke 2009; 4: 294-299
  • 28 Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: Description of a new technic and a preliminary report of its application. Circulation 1964; 30: 654-670
  • 29 Mathias K. A new catheter system for percutaneous transluminal angioplasty (PTA) of carotid artery stenoses. Fortschritte der Medizin 1977; 95: 1007-1011 Ein neuartiges Katheter-System zur perkutanen transluminalen Angioplastie von Karotisstenosen
  • 30 Wholey MH, Al-Mubarek N. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interven 2003; 60: 259-266
  • 31 Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ. et al Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: 1493-1501
  • 32 Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): A randomised trial. Lancet 2001; 357: 1729-1737
  • 33 Ederle J, Bonati LH, Dobson J, Featherstone RL, Gaines PA, Beard JD. et al Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): Long-term follow-up of a randomised trial. Lancet Neurol 2009; 8: 898-907
  • 34 Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK. et al Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008; 358: 1572-1579
  • 35 Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M. et al 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: A randomised non-inferiority trial. Lancet 2006; 368: 1239-1247
  • 36 Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W. et al Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: A multinational, prospective, randomised trial. Lancet Neurol 2008; 7: 893-902
  • 37 Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP. et al Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355: 1660-1671
  • 38 Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A. et al Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: Results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008; 7: 885-892
  • 39 Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ. et al Carotid artery stenting comparedwith endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomised controlled trial. Lancet 2010; 375: 985-997
  • 40 Brott TG, Hobson 2nd RW, Howard G, Roubin GS, Clark WM, Brooks W. et al Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363: 11-23
  • 41 Hopkins LN, Roubin GS, Chakhtoura EY, Gray WA, Ferguson RD, Katzen BT. et al The Carotid Revascularization Endarterectomy versus Stenting Trial: Credentialing of interventionalists and final results of lead-in phase. J Stroke Cerebrovasc Dis 2010; 19: 153-162
  • 42 Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): Stenting versus carotid endarterectomy for carotid disease. Stroke 2010; 41 (10) Suppl S31-S34
  • 43 Adams Jr HP. Management of carotid artery stenosis: Endarterectomy or stenting?. Mayo Clinic Proc 2010; 85: 1071-1072
  • 44 Amarenco P, Labreuche J, Mazighi M. Lessons from carotid endarterectomy and stenting trials. Lancet 2010; 376: 1028-1031
  • 45 Davis SM, Donnan GA. Carotid-artery stenting in stroke prevention. N Engl J Med 2010; 363: 80-82
  • 46 Bonati LH, Dobson J, Algra A, Branchereau A, Chatellier G, Fraedrich G. et al Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: A preplanned meta-analysis of individual patient data. Lancet 2010; 376: 1062-1073
  • 47 Bangalore S, Kumar S, Wetterslev J, Bavry AA, Gluud C, Cutlip DE. et al Carotid artery stenting vs carotid endarterectomy: Meta-analysis and diversity-adjusted trial sequential analysis of randomized trials. Arch Neurol 2011; 68: 172-184
  • 48 Lacroix V, Hammer F, Astarci P, Duprez T, Grandin C, Cosnard G. et al Ischemic cerebral lesions after carotid surgery and carotid stenting. Eur J Vasc Endovasc Surg 2007; 33: 430-435
  • 49 Schnaudigel S, Groschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: A systematic review of the literature. Stroke 2008; 39: 1911-1919
  • 50 Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ. et al New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: A substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9: 353-362
  • 51 McDonald RJ, Cloft HJ, Kallmes DF. Intracranial hemorrhage is much more common after carotid stenting than after endarterectomy: Evidence from the National Inpatient Sample. Stroke 2011; 42: 2782-2787
  • 52 Brott TG, Brown Jr RD, Meyer FB, Miller DA, Cloft HJ, Sullivan TM. Carotid revascularization for prevention of stroke: Carotid endarterectomy and carotid artery stenting. Mayo Clinic Proc 2004; 79: 1197-1208
  • 53 Ecker RD, Pichelmann MA, Meissner I, Meyer FB. Durability of carotid endarterectomy. Stroke 2003; 34: 2941-2944
  • 54 Perkins WJ, Lanzino G, Brott TG. Carotid stenting vs endarterectomy: New results in perspective. Mayo Clinic Proc 2010; 85: 1101-1108
  • 55 Barrett KM, Brott TG. Carotid artery stenting versus carotid endarterectomy: Current status. Neurol Clin 2006; 24: 681-695
  • 56 Moneley DS, Dueck A, Johnston KW. Carotid artery stenting: To be or not to be?. J Royal Coll Surg Edinburgh Ireland 2008; 6: 14-18
  • 57 Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: Results of a systematic review and analysis. Stroke 2009; 40: e573-e583
  • 58 Taussky P, Sangala JR, Meyer FB. Carotid endarterectomy and treatment options for carotid occlusive disease. World Neurosurg 2011; 76 (06) Suppl S35-S39
  • 59 Meyer FB, Meissner I, Fode NC, Losasso TJ. Carotid endarterectomy in elderly patients. Mayo Clinic Proc 1991; 66: 464-469
  • 60 Popovic IM, Seric V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci 2007; 257: 185-193