Seminars in Neurosurgery 2002; 13(3): 257-264
DOI: 10.1055/s-2002-39819
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

High-Risk Patients for Carotid Endarterectomy: The Candidates for Carotid Angioplasty and Stent Placement

Ricardo A. Hanel1 , Andrew R. Xavier2 , Amir M. Siddiqui2 , Jawad F. Kirmani2 , Bernard R. Bendok3 , Stanley H. Kim1 , Abutaher M. Yahia2 , L. N. Hopkins1 , Adnan I. Qureshi1,2
  • 1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
  • 2Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
  • 3Department of Neurological Surgery, Northwestern University, The Feinberg School of Medicine, Chicago, Illinois
Further Information

Publication History

Publication Date:
24 June 2003 (online)

ABSTRACT

Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer.[1] [2] Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs. By the year 2050, an estimated 1 million persons will suffer from stroke every year due to changes in age and ethnic distribution.[3] Approximately 25% of these ischemic events are related to occlusive disease of the cervical internal carotid artery.[4]

Carotid atherovascular stenosis increases the risk of ischemic stroke by acting as an embolic source and/or causing hypoperfusion of the ipsilateral cerebral hemisphere. Carotid endarterectomy (CEA), first performed by DeBakey in 1953,[5] involves arteriotomy of the cervical carotid artery with subsequent removal of athersclerotic plaque. This procedure has been shown to substantially reduce the risk of stroke associated with high-grade carotid stenosis.[6] [7] [8] During the last few years, carotid angioplasty and stenting (CAS) has evolved as an alternative to CEA, particularly in patients who are known to have a higher complication rate with CEA.[9] [10] The aim of this paper is to briefly review the indications and limitations of CEA, and show how CAS could be a safe and viable alternative in the management of high-risk CEA candidates.

REFERENCES

  • 1 American Stroke Association. Heart and Stroke Statistical Update. American Stroke Association, A Division of American Heart Association. Available at: www.americanheart.org. Accessed 2002
  • 2 Matchar D, Duncan P. Cost of stroke.  Stroke Clinical Update . 2002;  5 9-12
  • 3 Taylor T, Davis P, Torner J. Projected number of strokes by subtype in the year 2050 in the United States.  Stroke . 1998;  29 322
  • 4 Dyken M. Stroke risk factors. In: Norris J, Hachinski V, eds. Prevention of Stroke New York: Springer-Verlag 1991: 83-102
  • 5 DeBakey M E. Carotid endarterectomy revisited.  J Endovasc Surg . 1996;  3 4
  • 6 Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1991;  325 445-453
  • 7 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.  JAMA. 1995;  273 1421-1428
  • 8 Barnett H J, Taylor D W, Eliasziw M. et al . Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med . 1998;  339 1415-1425
  • 9 Roubin G S, New G, Iyer S S. et al . Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis.  Circulation . 2001;  103 532-537
  • 10 Yadav J S, Roubin G S, Iyer S. et al . Elective stenting of the extracranial carotid arteries.  Circulation . 1997;  95 376-381
  • 11 Ouriel K, Hertzer N R, Beven E G. et al . Preprocedural risk stratification: identifying an appropriate population for carotid stenting.  J Vasc Surg . 2001;  33 728-732
  • 12 Hsia D C, Krushat W M, Moscoe L M. Epidemiology of carotid endarterectomies among Medicare beneficiaries.  J Vasc Surg . 1992;  16 201-208
  • 13 Rothwell P M, Slattery J, Warlow C P. A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis.  Stroke . 1996;  27 260-265
  • 14 Wennberg D E, Lucas F L, Birkmeyer J D, Bredenberg C E, Fisher E S. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics.  JAMA . 1998;  279 1278-1281
  • 15 Goldstein L B, McCrory D C, Landsman P B. et al . Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms.  Stroke . 1994;  25 1116-1121
  • 16 Goldstein L B, Samsa G P, Matchar D B, Oddone E Z. Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis.  Stroke . 1998;  29 750-753
  • 17 Paciaroni M, Eliasziw M, Kappelle L J, Finan J W, Ferguson G G, Barnett H J. Medical complications associated with carotid endarterectomy. North American Symptomatic Carotid Endarterectomy Trial (NASCET).  Stroke . 1999;  30 1759-1763
  • 18 Sundt T M, Sandok B A, Whisnant J P. Carotid endarterectomy: complications and preoperative assessment of risk.  Mayo Clin Proc . 1975;  50 301-306
  • 19 Alamowitch S, Eliasziw M, Algra A, Meldrum H, Barnett H J. Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis.  Lancet . 2001;  357 1154-1160
  • 20 Ringer A, Lanzino G, Fessler R, Qureshi A, Guterman L, Hopkins, eds. L. Carotid Angioplasty and Stenting.  Advances in Vascular Surgery, No. 9 St. Louis, MO: Mosby 2001
  • 21 Harbaugh R E, Stieg P E, Moayeri N, Hsu L. Carotid-coronary artery bypass graft conundrum.  Neurosurgery . 1998;  43 926-931
  • 22 Ferguson G G, Eliasziw M, Barr H W. et al . The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients.  Stroke . 1999;  30 1751-1758
  • 23 Faggioli G L, Curl G R, Ricotta J J. The role of carotid screening before coronary artery bypass.  J Vasc Surg . 1990;  12 731
  • 24 Del Sette M, Eliasziw M, Streifler J Y, Hachinski V C, Fox A J, Barnett H J. Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group.  Stroke . 2000;  31 631-636
  • 25 Lopes D K, Mericle R A, Lanzino G, Wakhloo A K, Guterman L R, Hopkins L N. Stent placement for the treatment of occlusive atherosclerotic carotid artery disease in patients with concomitant coronary artery disease.  J Neurosurg . 2002;  96 490-496
  • 26 Moore W S, Barnett H J, Beebe H G. et al . Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the ad hoc committee, American Heart Association.  Stroke . 1995;  26 188-201
  • 27 Kim S, Mericle R, Lanzino G, Qureshi A, Guterman L, Hopkins L. Carotid angioplasty and stent placement in patients with tandem stenosis.  Neurosurgery . 1998;  43 708A
  • 28 Villarreal J, Silva J, Eliasziw M. Prognosis of patients with intraluminal thrombus in internal carotid artery.  Stroke . 1997;  29 276A
  • 29 Gasecki A P, Eliasziw M, Ferguson G G, Hachinski V, Barnett H J. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.  J Neurosurg . 1995;  83 778-782
  • 30 Meyer F B, Piepgras D G, Fode N C. Surgical treatment of recurrent carotid artery stenosis.  J Neurosurg . 1994;  80 781-787
  • 31 AbuRahma A F, Jennings T G, Wulu J T, Tarakji L, Robinson P A. Redo carotid endarterectomy versus primary carotid endarterectomy.  Stroke . 2001;  32 2787-2792
  • 32 Lanzino G, Mericle R A, Lopes D K, Wakhloo A K, Guterman L R, Hopkins L N. Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis.  J Neurosurg . 1999;  90 688-694
  • 33 Loftus C M, Biller J, Hart M N, Cornell S H, Hiratzka L F. Management of radiation-induced accelerated carotid atherosclerosis.  Arch Neurol . 1987;  44 711-714
  • 34 Melliere D, Becquemin J P, Berrahal D, Desgranges P, Cavillon A. Management of radiation-induced occlusive arterial disease: a reassessment.  J Cardiovasc Surg (Torino) . 1997;  38 261-269