Cervical carotid revascularization

Not all patients with symptomatic carotid stenosis are good candidates for CEA. Some patients have confounding comorbidites that increase their risk for morbidity and mortality during open surgical revascularization. Carotid angioplasty and stent placement may provide a lower-risk alternative for revascularization in selected patients. Stent devices are being designed specifically for revascularization of the carotid artery. As the technology improves, the morbidity and mortality rates associated with endovascular revascularization of the carotid artery should decrease. The steep learning curve associated with endovascular revascularization can result in numerous complications early in a surgeon's clinical experience. Distal protection devices may prevent stroke caused by liberation of embolic material during angioplasty and stent placement. CEA has demonstrated safety and efficacy for symptomatic carotid stenosis, but the benefits of CEA in the population with asymptomatic carotid stenosis are not as dramatic as symptomatic stenosis. Endovascular revascularization should be reserved for patients who are at significant risk for CEA-related morbidity and mortality. Asymptomatic patients with carotid stenosis should be treated with CEA unless the confounding risk for medical comorbidity is high. Patients who are good candidates for CEA should be revascularized using angioplasty and stent techniques only if they are enrolled in a prospective registry or trial.