Carotid endarterectomy: current consensus and controversies.

Robbert Meerwaldt, Linda Hermus, Michel M P J Reijnen, Clark J. Zeebregts (Corresponding Author)

Research output: Contribution to journalReview articleAcademicpeer-review

11 Citations (Scopus)

Abstract

Stroke is the third most common cause of mortality, and carotid artery stenosis causes 8% to 29% of all ischemic strokes. Best medical treatment forms the basis of carotid stenosis treatment, and carotid endarterectomy (CEA) has an additional beneficial effect in high-grade stenosis. Carotid angioplasty and stenting (CAS) has challenged CEA as a primary carotid intervention. At present, CEA remains the gold standard, but in the future, CAS techniques will evolve and might become beneficial for subgroups of patients with carotid stenosis. This chapter briefly describes the history of carotid interventions and current consensus and controversies in CEA. In the last two years, several meta-analyses were published on a variety of aspects of best medical treatment, CEA, and CAS. It is still a matter of debate as to whether asymptomatic patients with carotid stenosis should undergo a carotid intervention. Especially because medical treatment has dramatically evolved since the early carotid trials. On the other hand, it is clear that carotid interventions in symptomatic patients with a high-grade stenosis should be performed as early as possible after the initial neurological event in order to achieve optimal stroke risk reduction. In CEA, the use of patching is advocated above primary closure, while the role of selective patching is still unclear. No differences in stroke and mortality rates are observed for routine versus selective shunting, for conventional versus eversion CEA, or for local versus general anesthesia. It is anticipated that in the future, there will be several interesting developments in carotid interventions such as plaque morphology analysis, acute interventions during stroke in progress, and further evolvement of CAS techniques.

Original languageEnglish
Pages (from-to)283-291
Number of pages9
JournalSurgical technology international
Volume20
Publication statusPublished - 1 Oct 2010
Externally publishedYes

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Carotid Endarterectomy
Consensus
Carotid Stenosis
Angioplasty
Stroke
Pathologic Constriction
Mortality
Risk Reduction Behavior
Therapeutics
General Anesthesia
Meta-Analysis
History

Cite this

Meerwaldt, Robbert ; Hermus, Linda ; Reijnen, Michel M P J ; Zeebregts, Clark J. / Carotid endarterectomy : current consensus and controversies. In: Surgical technology international. 2010 ; Vol. 20. pp. 283-291.
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Meerwaldt, R, Hermus, L, Reijnen, MMPJ & Zeebregts, CJ 2010, 'Carotid endarterectomy: current consensus and controversies.' Surgical technology international, vol. 20, pp. 283-291.

Carotid endarterectomy : current consensus and controversies. / Meerwaldt, Robbert; Hermus, Linda; Reijnen, Michel M P J; Zeebregts, Clark J. (Corresponding Author).

In: Surgical technology international, Vol. 20, 01.10.2010, p. 283-291.

Research output: Contribution to journalReview articleAcademicpeer-review

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