Risk-Benefit Assessment of Carotid Revascularization

Abstract

Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes. To review the main studies on carotid revascularization, evaluating the relationship between risks and benefits of this procedure. The data reviewed show that, for a net benefit, carotid intervention should only be performed in cases of a periprocedural risk of less than 6% in symptomatic patients. The medical therapy significantly reduced the revascularization net benefit ratio for stroke prevention in asymptomatic patients. Real life registries indicate that carotid stenting is associated with a greater periprocedural risk. The operator annual procedure volume and patient age has an important influence in the rate of stroke and death after carotid stenting. Symptomatic patients have a higher incidence of death and stroke after the procedure. Revascularization has the greatest benefit in the first weeks of the event. There is a discrepancy in the scientific literature about carotid revascularization and/or clinical treatment, both in primary and secondary prevention of patients with carotid artery injury. The identification of patients who will really benefit is a dynamic process subject to constant review.

Figure 1

Percentage of Registries with a Lower than 3% Incidence of Stroke and Death in 30 days after Asymptomatic Carotid Intervention. CAS: Cardiotid angioplasty and stenting; CEA: Carotid endarterectomy. Paraskevas KI, Kalmykov EL, Naylor AR. Stroke/Death Rates Following Carotid Artery Stenting and Carotid Endarterectomy in Contemporary Administrative Dataset Registries: ASystematic Review. Eur J Vasc Endovasc Surg. 2015;51(1):3-12.

Figure 2

Percentage of Registries with a Lower than 6% Incidence of Stroke and Death in 30 days after Symptomatic Carotid Intervention. CAS: Cardiotid angioplasty and stenting; CEA: Carotid endarterectomy. Paraskevas KI, Kalmykov EL, Naylor AR. Stroke/Death Rates Following Carotid Artery Stenting and Carotid Endarterectomy in Contemporary Administrative Dataset Registries: ASystematic Review. Eur J Vasc Endovasc Surg. 2015;51(1):3-12.