ABSTRACT
Stroke is the third leading cause of death in the USA, after heart disease and lung cancer, and the leading cause of long-term disability in adults.1 Carotid endarterectomy is currently considered the standard of reference for treatment of atherosclerotic carotid occlusive disease. This has been validated by several randomized, controlled trials, proving the efficacy of endarterectomy over medical therapy. The North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) study has shown that endarterectomy is beneficial with symptomatic carotid artery stenosis of 70-99%.2 The indication for carotid endarterectomy has also been established in the Asymptomatic Carotid Artery Study (ACAS) for patients with asymptomatic carotid artery disease
of at least 60%.3 Surgical and endovascular procedures are available for local treatment of atherosclerotic lesions for high-risk patients. These procedures aim towards improving blood flow to the brain distal to a high-grade stenosis as well as removing an embolus-producing source. Carotid artery angioplasty with stenting is currently being investigated as an alternative treatment to carotid endarterectomy. The purpose of both endarterectomy and carotid stenting procedures is to prevent stroke from extracranial carotid artery atherosclerotic disease.
