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Seminars in Neurosurgery 2002; 13(3): 257-264
DOI: 10.1055/s-2002-39819
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

High-Risk Patients for Carotid Endarterectomy: The Candidates for Carotid Angioplasty and Stent Placement

Ricardo A. Hanel1 , Andrew R. Xavier2 , Amir M. Siddiqui2 , Jawad F. Kirmani2 , Bernard R. Bendok3 , Stanley H. Kim1 , Abutaher M. Yahia2 , L. N. Hopkins1 , Adnan I. Qureshi1,2
  • 1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
  • 2Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
  • 3Department of Neurological Surgery, Northwestern University, The Feinberg School of Medicine, Chicago, Illinois
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Publication History

Publication Date:
24 June 2003 (online)

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ABSTRACT

Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer.[1] [2] Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs. By the year 2050, an estimated 1 million persons will suffer from stroke every year due to changes in age and ethnic distribution.[3] Approximately 25% of these ischemic events are related to occlusive disease of the cervical internal carotid artery.[4]

Carotid atherovascular stenosis increases the risk of ischemic stroke by acting as an embolic source and/or causing hypoperfusion of the ipsilateral cerebral hemisphere. Carotid endarterectomy (CEA), first performed by DeBakey in 1953,[5] involves arteriotomy of the cervical carotid artery with subsequent removal of athersclerotic plaque. This procedure has been shown to substantially reduce the risk of stroke associated with high-grade carotid stenosis.[6] [7] [8] During the last few years, carotid angioplasty and stenting (CAS) has evolved as an alternative to CEA, particularly in patients who are known to have a higher complication rate with CEA.[9] [10] The aim of this paper is to briefly review the indications and limitations of CEA, and show how CAS could be a safe and viable alternative in the management of high-risk CEA candidates.

KEYWORDS

Carotid artery disease - angioplasty - stent - high-risk patients

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