Standards of Practice for Carotid Angioplasty and Stenting
Standards of Practice for Carotid Angioplasty and Stenting
Over the past 20 years, numerous clinical trials have compared CEA with medical management for extracranial carotid disease. For symptomatic patients with high-grade stenosis, the European Carotid Surgery Trial (ECST), the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Veterans Affairs Cooperative Study (VACS) all showed superiority of CEA over medical management in stroke risk reduction. In particular, for symptomatic patients with >70% carotid stenosis, NASCET showed a 2-year reduction in the risk of stroke or death from 26% to 9% with CEA compared with medical management alone. More recently, however, there has been some controversy with respect to the benefit of CEA for patients with asymptomatic carotid disease. While the Asymptomatic Carotid Atherosclerosis Study (ACAS) showed a 5-year reduction in the risk of stroke or death from 11% to 5% with CEA compared with medical management, improvements in 'best medical management' have led to equivalent reductions in the risk of stroke with medical management alone. Future randomized trials comparing present-day 'best medical management' with carotid revascularization (CEA and CAS) for asymptomatic patients are being planned.
Carotid Endarterectomy
Over the past 20 years, numerous clinical trials have compared CEA with medical management for extracranial carotid disease. For symptomatic patients with high-grade stenosis, the European Carotid Surgery Trial (ECST), the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Veterans Affairs Cooperative Study (VACS) all showed superiority of CEA over medical management in stroke risk reduction. In particular, for symptomatic patients with >70% carotid stenosis, NASCET showed a 2-year reduction in the risk of stroke or death from 26% to 9% with CEA compared with medical management alone. More recently, however, there has been some controversy with respect to the benefit of CEA for patients with asymptomatic carotid disease. While the Asymptomatic Carotid Atherosclerosis Study (ACAS) showed a 5-year reduction in the risk of stroke or death from 11% to 5% with CEA compared with medical management, improvements in 'best medical management' have led to equivalent reductions in the risk of stroke with medical management alone. Future randomized trials comparing present-day 'best medical management' with carotid revascularization (CEA and CAS) for asymptomatic patients are being planned.
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