What are the current indications for endovascular repair vs. open endarterectomy for carotid artery stenosis?
It was noted that open carotid endarterectomy remains the gold standard for the prevention of stroke due to symptomatic carotid artery stenosis. These results in part are related to the North American Symptomatic Carotid Endarterectomy Trial (NASCET): absolute risk reduction was only 17% at 2 years for patients with greater than 70% stenosis; the number of operations needed were 6 or less in order to prevent 1 patient from having a disabling stroke or death; benefit is durable, lasting upwards of 8 years and the benefit of surgery actually increases with age. It was noted that the following situations are generally accepted as relative indications for carotid angioplasty stenting (CAS) versus (vs.) carotid endarterectomy (CEA): Location of the atherosclerotic plaque: Carotid balloon angioplasty and stenting entered clinical practice originally because of its ability to access lesions which were beyond the reach of surgery, for example at the origin of the carotid artery in the thorax,
