The role of carotid endarterectomy in the management of carotid artery disease and stroke

Abstract

Background: Carotid endarterectomy to surgically clear the carotid artery bifurcation of atherosclerotic material was at one time one of the most common surgical procedures performed in this country. In recent years, however, there has been intense controversy over the appropriateness and efficacy of this procedure for the prevention of ischemic stroke.

Methods: This paper will first review the terminology and pathophysiology of cerebrovascular occlusive disease. The carotid endarterectomy procedure, as well as diagnostic techniques for the evaluation of carotid artery disease, will be described. Finally, the controversy surrounding the indications, benefits, and risks of carotid endarterectomy, the results of recent clinical trials and current recommendations for utilization will be discussed.

Results and conclusions: Initial results from multi-center clinical trials demonstrate that carotid endarterectomy can reduce the risk of subsequent stroke in patients with high grade (70-99 percent) stenosis who are symptomatic (i.e. who have had a documented ipsilateral transient ischemic attack or minor stroke). The complication rate of the surgeon, the patient's overall medical status, and the method of determining carotid stenosis should be factored into the decision to proceed. Surgical guidelines are less clear for patients with only moderate carotid stenosis or who are asymptomatic.