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STATE-OF-THE-ART PAPER

Optimal Treatment of Carotid Artery Disease

Elad I. Levy, MD^_*,,,_*, J. Mocco, MD, MS^_*,, Rodney M. Samuelson, MD^_*,, Robert D. Ecker, MD^_*,, Babak S. Jahromi, MD, PhD^_*, and L. Nelson Hopkins, MD^_*,,

^_* Departments of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York
Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York.

Manuscript received October 26, 2007; accepted October 31, 2007.

^_* Reprint requests and correspondence: Dr. Elad I. Levy, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, 3 Gates Circle, Buffalo New York 14209. (Email: elevy{at}buffns.com).

Extracranial carotid artery disease accounts for approximately 25% of ischemic strokes. Although carotid endarterectomy (CEA) is the established gold standard for carotid revascularization, carotid artery angioplasty and stenting (CAS) is continually developing into a safer and more efficacious method of stroke prevention. Embolic protection, improving stent designs, and ever-increasing surgeon experience are propelling CAS towards equipoise with and possible superiority to CEA. One multicenter randomized trial and several nonrandomized registries have successfully established CAS as an accepted treatment for high-risk patients. Clinicians must strive to perform well-designed clinical trials that will continue to aid understanding and improve application of both endovascular and open techniques for extracranial carotid revascularization. We review the data published to date regarding the indications for and recent developments in the use of CAS.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CAS = carotid artery stenting   CEA = carotid endarterectomy   DWI = diffusion-weighted imaging   MI = myocardial infarction   TIA = transient ischemic attack