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Carotid Revascularization: An Update

Published online by Cambridge University Press:  02 December 2014

Cian J. O'Kelly ,
Ken S. Butcher ,
B. Elaine Marchak  and
J. Max Findlay
Cian J. O'Kelly
Affiliation:
Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
Ken S. Butcher
Affiliation:
Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
B. Elaine Marchak
Affiliation:
Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
J. Max Findlay*
Affiliation:
Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
*
Findlay, Department of Surgery, University of Alberta Hospital, 2D1.02 Mackenzie Centre, 8440 - 112 Street, Edmonton, Alberta, T6G 2B7, Canada.
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Abstract

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Symptomatic extracranial internal carotid artery stenosis poses a high short-time risk of ischemic cerebral stroke, as high as 20% to 30% in the first three months. Timely performed carotid endarterectomy (CEA) has been shown to be highly effective in reducing this risk although, in recent years, there has been great interest in replacing this procedure with less invasive carotid angioplasty and stenting (CAS). In this update we review recent studies and provide recommendations regarding the indications, methods and timing of surgical intervention as well as the anaesthetic management of CEA, and we report on recently published randomized controlled trials comparing CEA to CAS. We also provide recommendations regarding the sometime neglected but important medical management of patients undergoing carotid intervention, including antithrombotic and antihypertension therapy, lipid lowering agents, assistance with smoking cessation, and diabetes control.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 3 , May 2010 , pp. 320 - 335
Copyright
Copyright © The Canadian Journal of Neurological 2010

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