Carotid Revascularization in the Modern Era: A Comparative Review of Carotid Endarterectomy, Carotid Angioplasty and Stenting, and Transcarotid Artery Revascularization

Abstract

Carotid artery stenosis is a major cause of acute ischemic stroke, accounting for approximately 15% of cases. Although optimal medical therapy remains the cornerstone of management, current guidelines recommend consideration of surgical intervention for symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥70% stenosis. Extensive evidence supports carotid endarterectomy (CEA) as the gold standard procedure, whereas transfemoral carotid angioplasty and stenting (TF-CAS) and transcarotid artery revascularization (TCAR) offer safe alternatives for patients with high surgical risk. Emerging data suggest that TCAR provides safety and efficacy profiles comparable to CEA and superior to TF-CAS in select patients. Considering these findings, selecting an appropriate revascularization strategy should rely on a multidisciplinary, individualized risk–benefit assessment. This article aims to provide a comparative review of the latest evidence on clinical indications, surgical techniques, and outcomes for current carotid revascularization strategies.

Keywords

carotid stenosis - stent - endarterectomy - TCAR - revascularization

^‡ Both authors are listed as senior authors of this article.

Publication History

Received: 07 April 2025

Accepted: 14 August 2025

Article published online:
01 September 2025

• References

• 1 Tsao CW, Aday AW, Almarzooq ZI. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation 2023; 147 (08) e93-e621
• 2 Petty GW, Brown Jr RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999; 30 (12) 2513-2516
• 3 Abbott AL, Paraskevas KI, Kakkos SK. et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 2015; 46 (11) 3288-3301
• 4 den Hartog AG, Achterberg S, Moll FL. et al; SMART Study Group. Asymptomatic carotid artery stenosis and the risk of ischemic stroke according to subtype in patients with clinical manifest arterial disease. Stroke 2013; 44 (04) 1002-1007
• 5 Dodick DW, Meissner I, Meyer FB, Cloft HJ. Evaluation and management of asymptomatic carotid artery stenosis. Mayo Clin Proc 2004; 79 (07) 937-944
• 6 Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363 (9413): 915-924
• 7 North American Symptomatic Carotid Endarterectomy Trial Collaborators. Barnett HJM, Taylor DW, Haynes RB. et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325 (07) 445-453
• 8 Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke 1991; 22 (06) 816-817
• 9 Halliday A, Mansfield A, Marro J. et al; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363 (9420): 1491-1502
• 10 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273 (18) 1421-1428
• 11 Bushnell C, Kernan WN, Sharrief AZ. et al. 2024 guideline for the primary prevention of stroke: a guideline from the American Heart Association/American Stroke Association. Stroke 2024; 55 (12) e344-e424
• 12 Criswell BK, Langsfeld M, Tullis MJ, Marek J. Evaluating institutional variability of duplex scanning in the detection of carotid artery stenosis. Am J Surg 1998; 176 (06) 591-597
• 13 Gupta A, Kesavabhotla K, Baradaran H. et al. Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Stroke 2015; 46 (01) 91-97
• 14 AlMuhanna K, Hossain MM, Zhao L. et al. Carotid plaque morphometric assessment with three-dimensional ultrasound imaging. J Vasc Surg 2015; 61 (03) 690-697
• 15 Horev A, Honig A, Cohen JE. et al. Overestimation of carotid stenosis on CTA—real world experience. J Clin Neurosci 2021; 85: 36-40
• 16 Takaya N, Yuan C, Chu B. et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI—initial results. Stroke 2006; 37 (03) 818-823
• 17 Remonda L, Senn P, Barth A, Arnold M, Lövblad KO, Schroth G. Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. AJNR Am J Neuroradiol 2002; 23 (02) 213-219
• 18 Kaufmann TJ, Huston III J, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology 2007; 243 (03) 812-819
• 19 Naylor R, Rantner B, Ancetti S. et al; Esvs Guidelines Committee. Editor's Choice—European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur J Vasc Endovasc Surg 2023; 65 (01) 7-111
• 20 Pan B, Jin X, Jun L, Qiu S, Zheng Q, Pan M. The relationship between smoking and stroke: a meta-analysis. Medicine (Baltimore) 2019; 98 (12) e14872
• 21 Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71-86
• 22 Diener HC, Bogousslavsky J, Brass LM. et al; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364 (9431): 331-337
• 23 Baigent C, Keech A, Kearney PM. et al; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366 (9493): 1267-1278
• 24 Brinjikji W, Lehman VT, Kallmes DF. et al. The effects of statin therapy on carotid plaque composition and volume: a systematic review and meta-analysis. J Neuroradiol 2017; 44 (04) 234-240
• 25 Barnett HJ, Taylor DW, Eliasziw M. et al; North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 1998; 339 (20) 1415-1425
• 26 Hobson II RW, Weiss DG, Fields WS. et al; The Veterans Affairs Cooperative Study Group. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993; 328 (04) 221-227
• 27 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351 (9113): 1379-1387
• 28 Yadav JS, Wholey MH, Kuntz RE. et al; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351 (15) 1493-1501
• 29 Gurm HS, Yadav JS, Fayad P. et al; SAPPHIRE Investigators. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008; 358 (15) 1572-1579
• 30 Bonati LH, Dobson J, Featherstone RL. et al; International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 2015; 385 (9967): 529-538
• 31 Brott TG, Hobson II RW, Howard G. et al; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363 (01) 11-23
• 32 Kwolek CJ, Jaff MR, Leal JI. et al. Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg 2015; 62 (05) 1227-1234
• 33 Kashyap VS, Schneider PA, Foteh M. et al; ROADSTER 2 Investigators*. Early outcomes in the ROADSTER 2 study of transcarotid artery revascularization in patients with significant carotid artery disease. Stroke 2020; 51 (09) 2620-2629
• 34 Rosenfield K, Matsumura JS, Chaturvedi S. et al; ACT I Investigators. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med 2016; 374 (11) 1011-1020
• 35 Halliday A, Bulbulia R, Bonati LH. et al; ACST-2 Collaborative Group. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet 2021; 398 (10305): 1065-1073
• 36 Eckstein H-H, Ringleb P, Allenberg J-R. 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 (10) 893-902
• 37 Mas JL, Arquizan C, Calvet D. et al; EVA-3S Investigators. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke 2014; 45 (09) 2750-2756
• 38 Kleindorfer DO, Towfighi A, Chaturvedi S. et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke 2021; 52 (07) e364-e467
• 39 Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000; 284 (22) 2901-2906
• 40 Ois A, Cuadrado-Godia E, Rodríguez-Campello A, Jimenez-Conde J, Roquer J. High risk of early neurological recurrence in symptomatic carotid stenosis. Stroke 2009; 40 (08) 2727-2731
• 41 Strömberg S, Gelin J, Osterberg T, Bergström GM, Karlström L, Osterberg K. Swedish Vascular Registry (Swedvasc) Steering Committee. Very urgent carotid endarterectomy confers increased procedural risk. Stroke 2012; 43 (05) 1331-1335
• 42 Touzé E, Trinquart L, Felgueiras R. et al; Carotid Stenting Trialists' Collaboration. A clinical rule (sex, contralateral occlusion, age, and restenosis) to select patients for stenting versus carotid endarterectomy: systematic review of observational studies with validation in randomized trials. Stroke 2013; 44 (12) 3394-3400
• 43 Cui CL, Dakour-Aridi H, Eldrup-Jorgensen J, Schermerhorn ML, Siracuse JJ, Malas MB. Effects of timing on in-hospital and one-year outcomes after transcarotid artery revascularization. J Vasc Surg 2021; 73 (05) 1649-1657.e1
• 44 Cui CL, Dakour-Aridi H, Lu JJ, Yei KS, Schermerhorn ML, Malas MB. In-hospital outcomes of urgent, early, or late revascularization for symptomatic carotid artery stenosis. Stroke 2022; 53 (01) 100-107
• 45 Chuatrakoon B, Nantakool S, Rerkasem A, Orrapin S, Howard DP, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2022; 6 (06) CD000190
• 46 Wiske C, Arhuidese I, Malas M, Patterson R. Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. J Vasc Surg 2018; 68 (02) 416-425
• 47 Rerkasem A, Orrapin S, Howard DP, Nantakool S, Rerkasem K. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2021; 10 (10) CD000126
• 48 Pagliariccio G, Di Sario I, Capoccia L. et al. Carotid near-occlusion: surgical or conservative management? Retrospective multicenter study. Ann Vasc Surg 2024; 102: 133-139
• 49 Rothwell PM, Eliasziw M, Gutnikov SA. et al; Carotid Endarterectomy Trialists' Collaboration. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361 (9352): 107-116
• 50 Halliday A, Harrison M, Hayter E. et al; Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 2010; 376 (9746): 1074-1084
• 51 Meschia JF, Edwards L, Roubin G, Brott TG, Lal BK. CREST-2 commitment to rigorous assessment of carotid stenting for primary prevention of stroke. Stroke Vasc Intervent Neurol 2024; 4 (03) e001227
• 52 Reddy RP, Karnati T, Massa RE, Thirumala PD. Association between perioperative stroke and 30-day mortality in carotid endarterectomy: a meta-analysis. Clin Neurol Neurosurg 2019; 181: 44-51
• 53 Hye RJ, Voeks JH, Malas MB. et al. Anesthetic type and risk of myocardial infarction after carotid endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg 2016; 64 (01) 3-8.e1
• 54 Jashari F, Ibrahimi P, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: similarities and differences. Atherosclerosis 2013; 227 (02) 193-200
• 55 Malas MB, Dakour-Aridi H, Wang GJ. et al. Transcarotid artery revascularization versus transfemoral carotid artery stenting in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2019; 69 (01) 92-103.e2
• 56 Greenstein AJ, Chassin MR, Wang J. et al. Association between minor and major surgical complications after carotid endarterectomy: results of the New York Carotid Artery Surgery study. J Vasc Surg 2007; 46 (06) 1138-1144 , discussion 1145–1146
• 57 Ooi YC, Gonzalez NR. Management of extracranial carotid artery disease. Cardiol Clin 2015; 33 (01) 1-35
• 58 Naylor AR, Sillesen H, Schroeder TV. Clinical and imaging features associated with an increased risk of early and late stroke in patients with symptomatic carotid disease. Eur J Vasc Endovasc Surg 2015; 49 (05) 513-523
• 59 Roubin GS, Yadav S, Iyer SS, Vitek J. Carotid stent-supported angioplasty: a neurovascular intervention to prevent stroke. Am J Cardiol 1996; 78 (3A): 8-12
• 60 Garg N, Karagiorgos N, Pisimisis GT. et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther 2009; 16 (04) 412-427
• 61 Kastrup A, Gröschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 2003; 34 (03) 813-819
• 62 Barbato JE, Dillavou E, Horowitz MB. et al. A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg 2008; 47 (04) 760-765
• 63 Mokin M, Dumont TM, Chi JM. et al. Proximal versus distal protection during carotid artery stenting: analysis of the two treatment approaches and associated clinical outcomes. World Neurosurg 2014; 81 (3-4): 543-548
• 64 de Vries EE, Meershoek AJA, Vonken EJ, den Ruijter HM, van den Berg JC, de Borst GJ. ENDORSE Study Group. A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. J Vasc Surg 2019; 69 (06) 1952-1961.e1
• 65 Zhang G, Xiang D, Lu H. et al. Clinical outcomes of carotid artery stenting with open- versus closed-cell stents. J Neurointerv Surg 2025; jnis-2025-023058 Epub ahead of print
• 66 Squizzato F, Piazza M, Forcella E. et al. Impact of carotid stent design on embolic filter debris load during carotid artery stenting. Stroke 2023; 54 (10) 2534-2541
• 67 Khanna O, Sweid A, Mouchtouris N. et al. Radial artery catheterization for neuroendovascular procedures. Stroke 2019; 50 (09) 2587-2590
• 68 El Naamani K, Khanna O, Syal A. et al. A comparison of outcomes between transfemoral versus transradial access for carotid stenting. Neurosurgery 2023; 93 (02) 445-452
• 69 Jaroenngarmsamer T, Bhatia KD, Kortman H, Orru E, Krings T. Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis. J Neurointerv Surg 2020; 12 (01) 87-93
• 70 Howard G, Roubin GS, Jansen O. et al; Carotid Stenting Trialists' Collaboration. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 2016; 387 (10025): 1305-1311
• 71 Brott TG, Howard G, Roubin GS. et al; CREST Investigators. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med 2016; 374 (11) 1021-1031
• 72 Cui L, Han Y, Zhang S, Liu X, Zhang J. Safety of stenting and endarterectomy for asymptomatic carotid artery stenosis: a meta-analysis of randomised controlled trials. Eur J Vasc Endovasc Surg 2018; 55 (05) 614-624
• 73 Nallamothu BK, Gurm HS, Ting HH. et al. Operator experience and carotid stenting outcomes in Medicare beneficiaries. JAMA 2011; 306 (12) 1338-1343
• 74 Bonati LH, Jongen LM, Haller S. et al; ICSS-MRI study group. 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 (04) 353-362
• 75 Vasavada AM, Singh P, Firdaus A. et al. Carotid endarterectomy versus stenting for the treatment of patients with carotid artery stenosis: an updated systematic review and meta-analysis. Cureus 2023; 15 (02) e35070
• 76 Batchelder AJ, Saratzis A, Ross Naylor A. Editor's Choice—Overview of primary and secondary analyses from 20 randomised controlled trials comparing carotid artery stenting with carotid endarterectomy. Eur J Vasc Endovasc Surg 2019; 58 (04) 479-493
• 77 Ederle J, Davagnanam I, van der Worp HB. et al; ICSS investigators. Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): a prespecified analysis of data from a randomised trial. Lancet Neurol 2013; 12 (09) 866-872
• 78 Dias CG, Fajardo A, Martin GH. et al. Transcarotid revascularization results in patients over 70 years of age. Vasc Endovascular Surg 2023; 57 (02) 114-118
• 79 Pucciarelli A, Arcari A, Popusoi G. et al. Incidence and predictors of acute kidney injury in patients undergoing proximal protected carotid artery stenting. EuroIntervention 2018; 14 (03) e360-e366
• 80 Elsayed N, Vasudevan RS, Zarrintan S, Barleben A, Kashyap VS, Malas MB. TransCarotid Artery Revascularization can be safely performed in patients undergoing dialysis. Ann Vasc Surg 2023; 92: 57-64
• 81 Sujijantarat N, Antonios J, Koo A. et al. Transcarotid artery revascularization (TCAR): a technical video. J Neurointerv Surg 2022; 14 (08) 842
• 82 Malas MB, Leal Lorenzo JI, Nejim B. et al. Analysis of the ROADSTER pivotal and extended-access cohorts shows excellent 1-year durability of transcarotid stenting with dynamic flow reversal. J Vasc Surg 2019; 69 (06) 1786-1796
• 83 Mehta M, Kashyap V, Malas M. et al. The ROADSTER investigational device exemption trial leads to Food and Drug Administration approval of the first stent labeled for trans-carotid artery revascularization. J Vasc Surg 2016; 64 (03) 841-842
• 84 Kashyap VS, So KL, Schneider PA. et al. One-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial. J Vasc Surg 2022; 76 (02) 466-473.e1
• 85 Schermerhorn ML, Liang P, Dakour-Aridi H. et al. In-hospital outcomes of transcarotid artery revascularization and carotid endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2020; 71 (01) 87-95
• 86 Kibrik P, Alsheekh A, Holscher C, Zarkowsky DS, Abularrage CJ, Hicks CW. Transcarotid artery revascularization and carotid endarterectomy have similar superior perioperative outcomes compared with transfemoral carotid artery stenting among octogenarians in the vascular quality initiative. J Vasc Surg 2021; 74 (03) e28
• 87 Malas MB, Dakour-Aridi H, Kashyap VS. et al. Transcarotid revascularization with dynamic flow reversal versus carotid endarterectomy in the Vascular Quality Initiative Surveillance Project. Ann Surg 2022; 276 (02) 398-403
• 88 Naazie IN, Cui CL, Osaghae I, Murad MH, Schermerhorn M, Malas MB. A systematic review and meta-analysis of transcarotid artery revascularization with dynamic flow reversal versus transfemoral carotid artery stenting and carotid endarterectomy. Ann Vasc Surg 2020; 69: 426-436
• 89 Alpaslan A, Wintermark M, Pintér L, Macdonald S, Ruedy R, Kolvenbach R. Transcarotid artery revascularization with flow reversal. J Endovasc Ther 2017; 24 (02) 265-270
• 90 King AH, Kumins NH, Foteh MI, Jim J, Apple JM, Kashyap VS. The learning curve of transcarotid artery revascularization. J Vasc Surg 2019; 70 (02) 516-521
• 91 Stonko DP, Goldsborough III E, Kibrik P, Zhang G, Holscher CM, Hicks CW. Use of transcarotid artery revascularization, transfemoral carotid artery stenting, and carotid endarterectomy in the US from 2015 to 2019. JAMA Netw Open 2022; 5 (09) e2231944
• 92 ENROUTE Transcarotid Stent System – P140026/S016. U.S. Food & Drug Administration. Accessed March 27, 2025 at: https://www.fda.gov/medical-devices/recently-approved-devices/enroute-transcarotid-stent-system-p140026s016
• 93 Liang P, Cronenwett JL, Secemsky EA. et al. Risk of stroke, death, and myocardial infarction following transcarotid artery revascularization vs carotid endarterectomy in patients with standard surgical risk. JAMA Neurol 2023; 80 (05) 437-444
• 94 National Library of Medicine. Post-approval Study of Transcarotid Artery Revascularization in Standard Risk Patients with Significant Carotid Artery Disease. Clinical Trials.gov; 2023
• 95 Columbo JA, Martinez-Camblor P, O'Malley AJ. et al. Association of adoption of transcarotid artery revascularization with center-level perioperative outcomes. JAMA Netw Open 2021; 4 (02) e2037885-e2037885
• 96 Teter K, Rockman C, Lamparello P. et al. Risk factors for and intraoperative management of intolerance to flow reversal in TCAR. Ann Vasc Surg 2022; 79: 41-45
• 97 Elsayed N, Yei KS, Naazie I, Goodney P, Clouse WD, Malas M. The impact of carotid lesion calcification on outcomes of carotid artery stenting. J Vasc Surg 2022; 75 (03) 921-929
• 98 Lee KB, Tanenbaum MT, Wang A. et al. Impact of head and neck radiation on long-term outcomes after carotid revascularization. J Vasc Surg 2024; 80 (02) 422-430
• 99 Kokkinidis DG, Chaitidis N, Giannopoulos S. et al. Presence of contralateral carotid occlusion is associated with increased periprocedural stroke risk following CEA but not CAS: a meta-analysis and meta-regression analysis of 43 studies and 96,658 patients. J Endovasc Ther 2020; 27 (02) 334-344
• 100 Dakour-Aridi H, Elsayed N, Malas M. Outcomes of carotid revascularization in patients with contralateral carotid artery occlusion. J Am Coll Surg 2021; 232 (05) 699-708.e1
• 101 Hanel RA, Jaikumar V, Gutierrez-Aguirre SF. et al. Adjunctive intravascular lithotripsy for heavily calcified carotid stenosis: a dual-center experience and technical case series. J Neurointerv Surg 2025; jnis-2024 –022545. Epub ahead of print
• 102 Tepe G, Brodmann M, Werner M. et al; Disrupt PAD III Investigators. Intravascular lithotripsy for peripheral artery calcification: 30-day outcomes from the randomized disrupt PAD III trial. JACC Cardiovasc Interv 2021; 14 (12) 1352-1361
• 103 Kereiakes DJ, Hill JM, Shlofmitz RA. et al; Disrupt CAD III Investigators. Intravascular lithotripsy for treatment of severely calcified coronary arteries: 2-year results—Disrupt CAD III study. JACC Cardiovasc Interv 2023; 16 (19) 2472-2474
• 104 DiLosa K, Schonefeld S, El-Khoury R. et al. Multi-center experience with intravascular lithotripsy for treatment of severe calcification during transcarotid artery revascularization for high-risk patients. J Vasc Surg 2024; 80 (03) 757-763
• 105 Giannopoulos S, Speziale F, Vadalà G. et al. Intravascular lithotripsy for treatment of calcified lesions during carotid artery stenting. J Endovasc Ther 2021; 28 (01) 93-99
• 106 Simioni A, Neves PF, Kabeil M, Jacobs D, Matsumura J, Yi J. Surveillance and risk factors for early restenosis following transcarotid artery revascularization. J Vasc Surg 2024; 79 (05) 1110-1118
• 107 Stilo F, Montelione N, Calandrelli R. et al. The management of carotid restenosis: a comprehensive review. Ann Transl Med 2020; 8 (19) 1272
• 108 Arhuidese IJ, Faateh M, Nejim BJ, Locham S, Abularrage CJ, Malas MB. Risks associated with primary and redo carotid endarterectomy in the endovascular era. JAMA Surg 2018; 153 (03) 252-259
• 109 Elsayed N, Ramakrishnan G, Naazie I, Sheth S, Malas MB. Outcomes of carotid revascularization in the treatment of restenosis after prior carotid endarterectomy. Stroke 2021; 52 (10) 3199-3208
• 110 Hadar N, Raman G, Moorthy D. et al. Asymptomatic carotid artery stenosis treated with medical therapy alone: temporal trends and implications for risk assessment and the design of future studies. Cerebrovasc Dis 2014; 38 (03) 163-173
• 111 Goyal M, Menon BK, van Zwam WH. et al; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387 (10029): 1723-1731
• 112 Jacquin G, Poppe AY, Labrie M. et al. Lack of consensus among stroke experts on the optimal management of patients with acute tandem occlusion. Stroke 2019; 50 (05) 1254-1256
• 113 Blassiau A, Gawlitza M, Manceau PF. et al. Mechanical thrombectomy for tandem occlusions of the internal carotid artery—results of a conservative approach for the extracranial lesion. Front Neurol 2018; 9: 928
• 114 Endovascular Acute Stroke Intervention - Tandem OCclusion Trial (EASI-TOC). . Accessed March 27, 2025 at: https://www.clinicaltrials.gov/study/NCT04261478?cond=Stroke%20Acute&term=Tandem%20Occlusion&rank=4
• 115 Powers WJ, Rabinstein AA, Ackerson T. et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
• 116 Farooqui M, Zaidat OO, Hassan AE. et al. Functional and safety outcomes of carotid artery stenting and mechanical thrombectomy for large vessel occlusion ischemic stroke with tandem lesions. JAMA Netw Open 2023; 6 (03) e230736