Carotid artery stenosis: Medical, surgical, and endovascular approaches

The treatment of carotid artery stenosis has undergone tremendous change in the last 15 years. Multiple important prospective randomized trials have proved the benefit of both medical therapy (with antiplatelet agents and anticoagulants) and surgical therapy for symptomatic and asymptomatic carotid artery stenosis. The choice of therapy in a large population of patients with carotid artery stenosis can be based on class I data from prospective randomized clinical trials. However, an equally large subset of patients with carotid artery stenosis fall outside the eligibility criteria of many of the clinical trials because of multiple factors that include medical comorbidities and anatomic considerations. With these patients, individual decisions must be reached as to the appropriateness of medical, surgical, or endovascular intervention based on a rational evaluation of the available medical literature and the experience of the treating physicians. Copyright (C) 2000 by W.B. Saunders Company.