Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: endarterectomy or stent?

摘要

In the 1980s, a series of landmark clinical trials in Europe and North America were undertaken that compared "best medical therapy" with carotid endarterectomy for both symptomatic and asymptomatic carotid stenosis and solidified the role of carotid endarterectomy for severe bifurcation atheroma. However, these conclusions were not accepted without reservation by some. A number of neurologists remained, and still remain, highly skeptical of the role of endarterectomy in the neurologically asymptomatic patient. At the same time there were those who questioned the efficacy of endarterectomy in patients who were not eligible for the controlled trials. Since the publication of those trials, progress has been made in both medical and surgical management of patients with carotid stenosis and a new therapy, carotid angioplasty with stenting, has emerged as an alternative to endarterectomy.