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Optimal Treatment of Extracranial Carotid Artery Disease: Carotid Endarterectomy, Carotid Stenting, or Optimal Medical Therapy

  • Peripheral Vascular Disease (MR Jaff, Section Editor)
  • Published:
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Abstract

The optimal treatment of extracranial carotid artery disease is more controversial for asymptomatic than for symptomatic patients. Early trials comparing carotid endarterectomy to medical therapy alone demonstrated clear benefit of surgery in both symptomatic and asymptomatic populations. However, some believe that advances in medical therapy now lead to similar outcomes with optimal medical therapy alone and revascularization in asymptomatic patients. The role of carotid stenting is heavily debated, and the evidence base comparing carotid stenting to endarterectomy is limited primarily by inadequate operator experience as well as paucity of data in high surgical risk patients. A useful clinical approach to carotid bifurcation disease is to categorize patients by symptomatic status and revascularization risk. For symptomatic patients, revascularization should be favored over medical therapy alone. For asymptomatic patients, medical therapy alone might be considered, particularly for patients at high risk of revascularization and with anticipated survival <3–5 years.

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R. Kevin Rogers and Kalkidan Bishu declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Cardiology, University of Colorado, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO, 80045, USA

    R. Kevin Rogers & Kalkidan Bishu

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  1. R. Kevin Rogers
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  2. Kalkidan Bishu
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Correspondence to R. Kevin Rogers.

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This article is part of the Topical Collection on Peripheral Vascular Disease

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Rogers, R.K., Bishu, K. Optimal Treatment of Extracranial Carotid Artery Disease: Carotid Endarterectomy, Carotid Stenting, or Optimal Medical Therapy. Curr Cardiol Rep 17, 84 (2015). https://doi.org/10.1007/s11886-015-0636-2

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  • DOI: https://doi.org/10.1007/s11886-015-0636-2

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