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(Circulation. 1997;95:303-305.)
© 1997 American Heart Association, Inc.

Articles

Elective Stenting of Extracranial Carotid Arteries

James Grotta, MD

the University of Texas Houston Medical School.

Correspondence to James Grotta, MD, Professor of Neurology and Director, Stroke Program, University of Texas Houston Medical School, Houston, TX 77030.

Key Words: Editorials • stroke • stents • arteries

	Introduction

 
The efficacy of surgical carotid endarterectomy (CEA) for extracranial carotid stenosis has now been unequivocally demonstrated. The publication of several large worldwide trials^{1 2 3 4} has finally provided clinicians with critically important data for practical management of a group of patients at particularly high risk of stroke: those with transient ischemic attacks (TIAs) or minor strokes referable to a high-grade stenosis at the carotid bifurcation. These data come after more than 20 years of inconclusive, noncontrol case studies and are the result of cooperative efforts of neurologists, neurosurgeons, and vascular surgeons to address the question of the efficacy of CEA in proper prospective randomized trials. The field of angioplasty/stenting (AS) for carotid disease has much to learn from the CEA experience.

In patients with TIAs or minor stroke, the CEA trials have shown the following: (1) if the symptoms are referable to a >70% diameter stenosis at the carotid bifurcation, CEA reduces the risk of subsequent ipsilateral stroke from 26% during the first 2 years with optimal medical management to 9% if CEA is added; (2) the risk of stroke without surgery is greater with increasing degrees of stenosis, reaching >30% during the first year for 90% to 95% stenosis; (3) surgery is not of benefit for <50% stenosis; (4) the risk/benefit of CEA for 50% to 70% stenosis remains unknown and is still under investigation; (5) although the best way to measure stenosis is debated, these degrees of stenosis assume a standard method of measurement comparing the narrowest lumen diameter at . . . [Full Text of this Article]

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