How is carotid stenosis treated

How is carotid stenosis treated

Patients with symptomatic carotid stenosis >70% should be treated with carotid endarterectomy (CEA) or stenting within 2 weeks of a TIA or nondisabling stroke: risk of recurrent stroke is 15% per year, and CEA cuts it in half.

Patients with 50% to 70% symptomatic stenosis benefit less from carotid intervention but have the same upfront procedure risk.

Asymptomatic patients with ≥60% stenosis have a 2% to 4% annual stroke rate that is cut in half after CEA; however, upfront risk of death or stroke from the procedure is 3% to 6%, so overall benefit is less than for symptomatic disease.

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) comparing CEA with stenting showed higher stroke and death rates in the stenting group, but higher myocardial infarction rates with CEA: overall rates of the combined endpoint were not different.

Older patients fared better with CEA than carotid stenting, and quality of life was better in those with myocardial infarction than in those with stroke.

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