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Carotid Revascularization: An Update

  • Cian J. O'Kelly (a1), Ken S. Butcher (a2), B. Elaine Marchak (a3) and J. Max Findlay (a1)


Symptomatic extracranial internal carotid artery stenosis poses a high short-time risk of ischemic cerebral stroke, as high as 20% to 30% in the first three months. Timely performed carotid endarterectomy (CEA) has been shown to be highly effective in reducing this risk although, in recent years, there has been great interest in replacing this procedure with less invasive carotid angioplasty and stenting (CAS). In this update we review recent studies and provide recommendations regarding the indications, methods and timing of surgical intervention as well as the anaesthetic management of CEA, and we report on recently published randomized controlled trials comparing CEA to CAS. We also provide recommendations regarding the sometime neglected but important medical management of patients undergoing carotid intervention, including antithrombotic and antihypertension therapy, lipid lowering agents, assistance with smoking cessation, and diabetes control.

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Corresponding author

Findlay, Department of Surgery, University of Alberta Hospital, 2D1.02 Mackenzie Centre, 8440 - 112 Street, Edmonton, Alberta, T6G 2B7, Canada.


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1. Hamelin, H, Sweet, WH, Lougheed, WM. Surgical reconstruction of occluded cervical carotid artery. J Neurosurg. 1958; 15: 42737.
2. Eastcott, HHG, Pickering, GW, Rob, CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of right hemiplegia. Lancet. 1954; 267: 9946.
3. Cooley, DA, Al-Naaman, YD, Carton, DA. Surgical treatment of arteriosclerotic occlusion of common carotid artery. J Neurosurg. 1956; 13: 5006.
4. Lougheed, WM, Elgie, RG, Barnett, HJM. The results of surgical management of extracranial internal carotid artery occlusion and stenosis. Can Med Assoc J. 1966; 95: 127993.
5. Barnett, HJ. Reflections on the carotid artery: 438 BC to 2009 AD. Stroke. 2009; 40: 31438.
6. Barnett, HJ. More personal reflections on life part III. Can J Neurol Sci. 2010; 37(2):1606.
7. Findlay, JM, Marchak, BE, Pelz, DM, Feasby, TE. Carotid endarterectomy: a review. Can J Neurol Sci. 2004; 31: 2236.
8. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991; 325: 44553.
9. Barnett, HJM, Taylor, DW, Eliasziw, M, Fox, AJ, Ferguson, GG, Haynes, BR, et al. for the North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998; 339: 141525.
10. European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991; 337: 123543.
11. European Carotid Surgery Trial. Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet. 1996; 347: 15913.
12. Mayberg, MR, Wilson, SE, Yatsu, F, Weiss, DG, Messina, L, Hershey, LA, et al. for the Veterans Affairs Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA. 1991; 266: 328994.
13. Findlay, JM, Nykolyn, L, Lubkey, RB, Wong, JH, Mouradian, M, Senthilselvan, A. Auditing carotid endarterectomy: a regional experience. Can J Neurol Sci. 2002; 29: 32632.
14. Halm, EA, Chassin, MR, Tuhrim, S, Hollier, LH, Popp, AJ, Ascher, E, et al. Revisiting the appropriateness of carotid endarterectomy. Stroke. 2003; 34: 146472.
15. Kennedy, J, Quan, H, Ghali, WA, Feasby, TE. Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in four Canadian provinces. CMAJ. 2004; 171(5): 4559.
16. Easton, JD, Saver, JL, Albers, GW, Albers, MJ, Chaturvedi, S, Fieldmann, E, et al. Definition and evaluation of transient ischemic attack. Stroke. 2009; 40:227693.
17. Shah, SH, Saver, JL, Kidwell, CE, Ay, H, Koroshetz, WJ, Inatome, Y, et al. A multicentre pooled patient-level data analysis of diffusion-weighted MRI in TIA patients. Stroke. 2007; 38: 463.
18. Rothwell, PM, Eliasziw, M, Gutnikov, SA, Warlow, CP, Barnett, HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004; 363: 91524.
19. Rothwell, PM, Eliasziw, M, Gutnikov, SA, Warlow, CP, Barnett, HJ. Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischemic attack and nondisabling stroke. Stroke. 2004; 35: 285561.
20. Alamowitch, S, Eliasziw, M, Barnett, HJ. for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the ASA and Carotid Endarterectomy (ACE) Trial Groups. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Stroke. 2005; 36: 2731.
21. Rothwell, PM, Gutnikov, SA, Warlow, CP. Reanalysis of the final results of the European carotid surgery trial. Stroke. 2003; 34: 51423.
22. Rothwell, PM, Eliasziw, M, Gutnikov, SA, Fox, AJ, Taylor, DW, Mayberg, MR, et al. Carotid Endarterectomy Trialists’ Collaboration. analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003; 361: 10716.
23. Rothwell, PM, Gibson, R, Warlow, CP., on behalf of the European Carotid Trailists’ Collaborative Group. Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. Stroke. 2000; 31: 61521.
24. Eliasziw, M, Streifler, JY, Fox, AJ, Hachinski, VC, Ferguson, GG, Barnet, HJ. Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. Stroke. 1994; 25: 3048.
25. Villareal, J, Silva, J, Eliasziw, M, Sharpe, B, Fox, A, Hachinski, V, et al,. for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Prognosis of patients with an intraluminal thrombus in the internal carotid artery. Stroke. 1998; 29: 276.
26. Kappelle, LJ, Eliasziw, M, Fox, AJ, Sharpe, BL, Barnett, HJ. Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. Stroke. 1999; 30: 2826.
27. Henderson, RD, Eliasziw, M, Fox, AJ, Rothwell, PM, Barnett, HJ. Angiography defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. Stroke. 2000; 31: 12832.
28. Streifler, JY, Eliasziw, M, Benavente, OR, Alamowitch, S, Fox, AJ, Hachinski, VC, et al. for the North American Symptomatic Carotid Endarterectomy Trial Group. Prognostic importance of leukoaraiosis in patients with symptomatic internal carotid artery stenosis. Stroke. 2003; 33: 164515.
29. Markus, HS, MacKinnon, A. Asymptomatic embolization detected by doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke. 2005; 36: 9715.
30. Johnston, SC, Gress, DR, Browner, WS, Sidney, S. Short-term prognosis after emergency-department diagnosis of TIA. JAMA 2000; 284: 29016.
31. Lovett, JK, Dennis, MS, Sandercock, PA, Bamford, J, Warlow, CP, Rothwell, PM. Very early risk of stroke after a first transient ischemic attack. Stroke. 2003; 34: e138-e42.
32. Gladstone, DJ, Kapral, MK, Fang, J, Laupacis, A, Tu, JV. Management and outcomes of transient ischemic attacks in Ontario. CMAJ. 2004; 170 (7): 1099104.
33. Eliasziw, M, Kennedy, J, Hill, MD, Buchan, AM, Barnett, HJ. for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Early risk of stroke after a transient ischemic attack in patients with internal carotid artery disease. CMAJ. 2004; 170 (7): 11059.
34. Coull, AJ, Lovett, JK, Rothwell, PM., on behalf of the Oxford Vascular Study. Population based study of early risk of stroke after transient ischemic attack or minor stroke: implications for public education and organization of services. BMJ. 2004 Feb 7;328(7435):326. Epub 2004 Jan 26.
35. Ois, A, Cuadrado-Godia, E, Rodriguez-Campello, A, Jimenez-Conde, J, Roquer, J. High risk of early neurological recurrence in symptomatic carotid stenosis. Stroke. 2009; 40: 272731.
36. Johnston, DC, Hill, MD. The patient with transient cerebral ischemia: a golden opportunity for stroke prevention. CMAJ. 2004; 170 (7): 11347.
37. Lindsay, P, Bayley, M, Hellings, C, Hill, M, Woodbury, E, Phillips, S., (Canadian Stroke Strategy Best Practices and Standards Writing Group on behalf of the Canadian Stroke Strategy, a joint initiative of the Canadian Stroke Network and the Heart and Stroke Foundation of Canada). Canadian best practice recommendations for stroke care (updated 2008). CMAJ. 2008; 179(12): S125.
38. Gladstone, DJ, Oh, J, Fang, J, Lindsay, P, Tu, JV, Silver, FL, et al. Urgency of carotid endarterectomy for secondary stroke prevention. Results from the Registry of the Canadian Stroke Network. Stroke. 2009; 40: 277682.
39. Halliday, A, Mansfield, A, Marro, J, Peto, C, Peto, R, Potter, J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004; 363: 1491502.
40. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for symptomatic carotid artery stenosis. JAMA. 1995; 273: 14218.
41. de Weerd, M, Greving, JP, de Jong, AW, Buskens, E, Bots, ML. Prevalence of asymptomatic carotid artery stenosis according to age and sex. Systematic review and metaregression analysis. Stroke. 2009; 40: 110513.
42. Goessens, BM, Visseren, FL, Kappelle, LJ, Algra, A, van der Graaf, Y., for the SMART Study Group. Asymptomatic carotid artery stenosis and the risk of new vascular events in patients with manifest arterial disease, The Smart Study. Stroke. 2007; 38: 14705.
43. Dick, P, Sherif, C, Sabeti, S, Amighi, J, Minar, E, Schillinger, M. Gender differences in outcome of conservatively treated patients with asymptomatic high grade carotid stenosis. Stroke. 2005; 36: 117883.
44. Inzitari, D, Eliasziw, M, Gates, P, Sharpe, BL, Chan, RKT, Meldrum, HE, et al. for the North American Symptomatic Carotid Endarterectomy Trial Collaborators. The causes and risk of stroke in patients with asymptomatic internal carotid artery stenosis. N Engl J Med. 2000; 342: 1693700.
45. The European Carotid Surgery Trialist Collaborative Group. Risk of stroke in the distribution of an asymptomatic carotid artery. Lancet. 1995; 345: 20912.
46. Heijenbrok-Kal, MH, Buskens, E, Nederkoorn, PJ, van der Graaf, Y, Hunink, MG. Optimal peak systolic velocity threshold at duplex US for determining the need for carotid endarterectomy: a decision analytic approach. Radiology. 2006; 238: 4808.
47. de Weert, TT, Cretier, S, Groen, HC, Homberg, P, Cakir, H, Wentzel, J, et al. Atherosclerotic plaque surface morphology in the carotid bifurcation assessed with multidetector computed tomography angiography. Stroke. 2009; 40: 133440.
48. Willinek, WA, von Falkenhausen, M, Born, M, Gieseke, J, Holler, T, Klockgether, T, et al. Noninvasive detection of steno-occlusive disease of the supra-aortic arteries with three-dimensional contrast-enhanced magnetic resonance angiography. A prospective, intra-individual comparative analysis with digital subtraction angiography. Stroke. 2005; 36: 3843.
49. Fisher, M, Paganini-Hill, A, Martin, A, Cosgrove, M, Toole, J, Barnett, HJ, et al. Carotid plaque pathology. Thrombosis, ulceration, and stroke pathogenesis. Stroke. 2005; 36: 2537.
50. Goncalves, I, Lindholm, M, Pedro, L, Dias, N, Fernandes e Fernandes, J, Fredrikson, GN, et al. Elastin and calcium rather than collagen or lipid content are associated with echogenicity of human carotid plaques. Stroke. 2004; 35: 2795800.
51. Sztajzel, R, Momjian, S, Momjian-Mayor, I, Murith, N, Djebaili, K, Boissard, G, et al. Stratified gray-scale median analysis and color mapping of the carotid plaque. Correlation with endarterectomy specimen histology of 28 patients. Stroke. 2005; 36: 7415.
52. Tureyen, K, Vemuganti, R, Salamat, MS, Dempsey, RJ. Increased angiogenesis and angiogenic gene expression in carotid artery plaques from symptomatic stroke patients. Neurosurgery. 2006; 58: 9717.
53. Nanadalur, KR, Hardie, AD, Raghavan, P, Schipper, MJ, Baskurt, E, Kramer, CM. Composition of the stable carotid plaque. Insights from a multidetector computed tomography study of plaque volume. Stroke. 2007; 38: 93540.
54. Atlaf, N, MacSweeney, ST, Gladman, J, Auer, DP. Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke. 2007; 38: 16335.
55. Gao, P, Chen, Z, Bao, Y, Jiao, L, Ling, F. Correlation between carotid intraplaque hemorrhage and clinical symptoms. Systematic review of observational studies. Stroke. 2007; 38: 238290.
56. Mannheim, D, Hermann, J, Versari, D, Gossl, M, Meyer, FB, McConnell, JP, et al. Enhanced expression of Lp-PLA2 lysophosphatidylcholine in symptomatic carotid atherosclerotic plaques. Stroke. 2008; 39: 114855.
57. Redgrave, J, Gallagher, P, Lovett, JK, Rothwell, PM. Critical cap thickness and rupture in symptomatic carotid plaques. The Oxford Plaque Study. Stroke. 2008; 39: 17229.
58. Bot, PT, Hoefer, IE, Sluijter, JP, van Vliet, P, Smits, AM, Lebrin, F, et al. Increased expression of the transforming growth factor-β signaling pathway, endoglin, and early growth response-1 in stable plaques. Stroke. 2009; 40: 43947.
59. Girard, L-P, Feasby, T, Eliasziw, M, Quan, H, Kennedy, J, Barnett, HJM, et al. Complication rates after left- versus right-sided carotid endarterectomy. Circ Cardiovasc Qual Outcomes. 2009; 2: 6427.
60. Bond, R, Rerkasem, K, AbuRahma, AF, Naylor, AR, Rothwell, PM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database of Systematic Reviews 2003, Issue 1. Art No: CD000160.
61. Mannheim, D, Weller, B, Vahadim, E, Karmeli, R. Carotid endarterectomy with polyurethane patch versus primary closure: a prospective randomized study. J Vasc Surg. 2005; 41: 4037.
62. Ali, T, Sabharwal, T, Dourado, RA, Padayachee, TS, Hunt, T, Burnand, KG. Sequential cohort study of Dacron® patch closure following carotid endarterectomy. Br J Surg. 2005; 92(3): 31621.
63. Al-Rawi, PG, Turner, CL, Waran, V, Ng, I, Kirkpatrick, PJ. A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy. Neurosurgery. 2006; 59(4): 8229.
64. Byrne, J, Feustel, P, Darling, RC. Primary closure, routine patching and eversion endarterectomy: what is the current state of the literature supporting use of these techniques? J Vasc Surg. 2007; 20: 22635.
65. Marien, BJ, Raffetto, JD, Seidman, CS, LaMorte, WW, Menzoian, JO. Bovine pericardium vs Dacron for patch angioplasty after carotid endarterectomy. Arch Surg. 2002; 137: 7858.
66. Bond, R, Rerkasem, K, Naylor, AR, Rothwell, PM. Cochrane Corner. Stroke. 2005; 36; 13501.
67. Asciutto, G, Geier, B, Marpe, B, Hummel, T, Mumme, A. Dacron patch infection after carotid angioplasty. A report of six cases. Eur J Vasc Endovasc Surg. 2007; 33 (1): 557.
68. Krishnan, S, Clowes, AW. Dacron patch infection after carotid endarterectomy: case report and review of the literature. Annals of Vasc Surg. 2006; 20(5): 6727.
69. Bond, R, Rerkasem, K, Rothwell, PM. Cochrane Corner. Stroke. 2003; 34:8245.
70. Woodworth, GF, McGirt, MJ, Than, KD, Huang, J, Perler, BA, Tamargo, RJ. Selective versus routine intraoperative shunting during carotid endarterectomy: a multivariate outcome analysis. Neurosurgery. 2007; 61: 11706.
71. Cunningham, EJ, Bond, R, Mayberg, MR, Warlow, CP, Rothwell, PM. Risk of persistent cranial nerve injury after carotid endarterectomy. J Neurosurg. 2004; 101: 4458.
72. Halm, EA, Tuhrim, S, Wang, JJ, Rockman, C, Riles, TS, Chassin, MR. Risk factors for perioperative death and stroke after carotid endarterectomy. Stroke. 2009; 40: 2219.
73. Bond, R, Rerkasem, K, Rothwell, PM. Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery. Stroke. 2003; 34: 2290303.
74. Chaturvedi, S, Madhaven, R, Santhakumar, S, Mehri-Basha, M, Raje, N. Higher risk factor burden and worse outcomes in urban carotid endarterectomy patients. Stroke. 2008; 39: 29668.
75. Ogasawara, K, Nobuyuki, S, Kuroiwa, T, Hosoda, K, Iihara, K, Toyoda, K, et al. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review or 4494 patients. J Neurosurg. 2007; 107: 11306.
76. Hosoda, K, Kawaguchi, T, Kazunari, I, Minoshima, S, Shibata, Y, Iwakura, M, et al. Prediction of hyperperfusion after carotid endarterectomy by brain SPECT analysis with semiquantitave statistical mapping method. Stroke. 2003; 34: 118793.
77. Ogasawara, K, Yukawa, H, Kobayashi, M, Mikami, C, Konno, H, Terasaki, K, et al. Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg. 2003; 99: 50410.
78. Suga, Y, Ogasawara, K, Saito, H, Komoribayashi, N, Kobayashi, M, Inoue, T, et al. Preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy correlate with development of postoperative cerebral hyperperfusion. Stroke. 2007; 38: 271217.
79. Fujimoto, S, Toyoda, K, Inoue, T, Hirai, Y, Uwatoko, T, Kishikawa, K, et al. Diagnostic impact of transcranial color-coded real-time sonography with echo contrast agents for hyperperfusion syndrome after carotid endarterectomy. Stroke. 2004; 35: 18526.
80. Kuroda, H, Ogasawara, K, Hirooka, R, Kobayashi, M, Fujiwara, S, Chida, K, et al. Prediction of cerebral hyperperfusion after carotid endarterectomy using middle cerebral artery signal intensity in preoperative single-slab 3-dimensional time-of-flight magnetic resonance angiography. Neurosurgery. 2009; 64: 106572.
81. Ogasawara, K, Inoue, T, Kobayashi, M, Endo, H, Fukuda, T, Ogawa, A. Pretreatment with the free radical scavenger edaravone prevents cerebral hyperperfusion after carotid endarterectomy. Neurosurgery. 2004; 55: 10607.
82. Kawamata, T, Okada, Y, Kawashima, A, Yoneyama, T, Yamaguchi, K, Ono, Y, et al. Postcarotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation. Neurosurgery. 2009; 64: 44754.
83. Coutts, S, Hill, M, Hu, W, Sutherland, G. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery. 2003; 53: 105360.
84. Mocco, J, Wilson, DA, Ducruet, AF, Komotar, RJ, Mack, WJ, Zurica, J, et al. Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy or asymptomatic carotid artery stenosis. Stroke. 2006; 37: 2402.
85. Ghogawala, Z, Westerveld, M, Amin-Hanjani, S. Cognitive outcomes after carotid revascularization: the role of cerebral emboli and hypoperfusion. Neurosurgery. 2008; 62: 38595.
86. Hirooka, R, Ogasawara, K, Sasaki, M, Yamadate, K, Kobayashi, M, Suga, Y, et al. Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. J Neurosurg. 2008; 108: 117883.
87. Chida, K, Ogasawara, K, Suga, Y, Hideo, S, Kobayashi, M, Yoshida, K, et al. Postoperative cortical neural loss associated with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. Stroke. 2009; 40: 44853.
88. De Rango, P, Caso, V, Leys, D, Paciaroni, M, Lenti, M, Cao, P. The role of carotid artery stenting and carotid endarterectomy in cognitive performance. A systematic review. Stroke. 2008; 39: 311627.
89. Pandit, JJ, Satya-Krishna, R, Gration, P. Superficial or deep cervical plexus block for carotid endarterecomy. Br J Anaesth. 2007; 99: 15969.
90. Roessel, T, Wiessner, D, Heller, AR, Zimmerman, T, Koch, T, Letz, RJ, et al. High-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy. Reg Anesth Pain Med. 2007; 32: 24753.
91. Howell, SJ. Carotid endarterectomy. Br J Anaesth. 2007; 99:11931.
92. Calligaro, KD, Dougherty, MJ. Correlation of carotid artery stump pressure and neurologic changes during 474 carotid endarterectomies performed in awake patients. J Vasc Surg. 2005; 42: 6849.
93. Jacob, T, Hingorani, A, Ascher, E. Carotid artery stump pressure in 1135 consecutive endarterectomies under general anesthesia: an old method that survived the test of times. J Cardiovasc Surg (Torino). 2007; 48: 67781.
94. Astarci, P, Guerit, JM, Robert, A, Elkhoury, G, Noirhomme, P, Rubay, J, et al. Stump pressure and somatosensory evoked potentials for predicting the use of shunt during carotid surgery. Ann Vasc Surg. 2007; 21: 3127.
95. Mulaudzi, TV, Biccard, BM, Robbs, JV, Paruk, N, Pillay, B, Rajaruthnam, P. Carotid artery stump pressure and associated neurological changes in predominantly symptomatic carotid artery disease patients undergoing awake carotid endarterectomy. Cardiovasc J Afr. 2009; 20: 11618.
96. Pugliese, F, Ruberto, F, Tosi, A, Martelli, S, Bruno, K, Summonti, D, et al. Regional cerebral saturation versus transcranial doppler during carotid endarterectomy under regional anesthesia. Eur J Anaesthesiol. 2009; 26: 6437.
97. Rigamonti, A, Scandroglio, M, Minicucci, F, Magrin, S, Carozzo, A, Casati, A, et al. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy. J Clin Anesth. 2005; 17: 42630.
98. Fassiadis, N, Zayed, H, Rashid, H, Green, DW. Invos Cerebral Oximeter compared with the transcranial doppler for monitoring adequacy of cerebral perfusion in patients undergoing carotid endarterectomy. Int Angiol. 2006; 25: 4016.
99. Yammamoto, K, Miyata, T, Nagawa, H. Good correlation between cerebral oxygenation measured using near infrared spectroscopy and stump pressure during carotid clamping. Int Angiol. 2007; 26: 2625.
100. Lee, TS, Hines, GL, Feuerman, M. Significant correlation between cerebral oximetry and carotid stump pressure during carotid endarterectomy. Ann Vasc Surg. 2008; 22: 5862.
101. Moritz, S, Kasprzak, P, Arlt, M. Accuracy of cerebral monitoring in detecting cerebral ischemia during carotid endarterectomy. Anesthesiology. 2007; 107: 5639.
102. Rerkasem, K, Bond, R, Rothwell, PM. Local versus general anesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2004; (2): CD 000126.
103. Rerkasem, K, Rothwell, PM. Local versus general anesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2008; (4): CD 000126.
104. GALA Collaborative Group, General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre randomized controlled trial. Lancet. 2008; 372: 213242.
105. Bussiere, M, Pelz, DM, Kalapos, P, Kalopos, P, Lee, D, Gulka, A, et al. Results using a self-expanding stent alone in the treatment of severe symptomatic carotid bifurcation stenosis. J Neurosurg. 2008; 109(3): 45460.
106. Lownie, SP, Pelz, DM, Lee, DH, Men, S, Gulka, I, Kalapos, P. Efficacy of treatment of severe carotid bifurcation stenosis by using self-expanding stents without deliberate use of angioplasty balloons. AJNR AM J Neuroradiol. 2005; 26(5AA): 12418.
107. Schnaudigel, S, Groschel, K, Pilgram, SM, Kastrup, A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke. 2008; 39(6): 191119.
108. Barbato, JE, Dillavou, E, Horowitz, MB, Jovin, TG, Kanal, E, David, S, et al. A randomized trial of carotid artery stenting with and without cerebral protection. J Vas Surg. 2008; 47(4): 7605.
109. Ederle, J, Featherstone, RL, Brown, MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2007(4); CD000515.
110. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS); a randomized trial. Lancet. 2001; 357: 172937.
111. Ringleb, PA, Allenberg, J, Bruckmann, H, Eckstein, HH, Fraedrich, G, Hartmann, M, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomized non-inferiority trial. Lancet. 2006; 368(9543): 123947.
112. Yadav, JS, Wholey, MH, Kuntz, RE, Fayad, P, Katzen, BT, Mishel, GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004; 351(15); 1493501.
113. Mas, JL, Chatellier, G, Beyssen, B, Branchereau, A, Moulin, J, Becquemin, JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006; 355 (16): 166071.
114. Brown, MB, Ederle, J, Bonati, L, Featherstone, RJ, Dobson, J. Safety results of the International Carotid Stenting Study (ICSS): early outcome of patients randomized between carotid stenting and endarterectomy for symptomatic carotid stenosis. XVIII European Stroke Conference; 2009 May 27; Stockholm, Sweden; 2009.
115. Eckstein, HH, Ringleb, P, Allenberg, JR, Berger, J, Fraedrich, G, Hacke, W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenosis at 2 years: a multinational, prospective, randomized trial. Lancet Neurol. 2008; 7(10): 893902.
116. Gurm, HS, Yadav, JS, Fayad, P, Katzen, B, Mishel, GJ, Bajwa, TK, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008; 358(15): 15729.
117. Mas, JL, Trinquart, L, Leys, D, Albucher, JF, Rousseau, H, Viguier, A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomized, multicentre trial. Lancet Neurol. 2008; 7(10): 88592.
118. Hobson, RW, 2nd, Howard, VJ, Roubin, GS, Brott, TG, Ferguson, RD, Popma, JJ, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004; 40(6): 110611.
119. Albers, GW, Amarenco, P, Easton, JD, Sacco, RL, Teal, P. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed). Chest. 2008 Jun; 133(Suppl 6): 630S69S.
120. Adams, RJ, Albers, G, Alberts, MJ, Benavente, O, Furie, K, Goldstein, LB, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008 May; 39(5):164752.
121. Lindsay, P, Bayley, M, McDonald, A, Graham, ID, Warner, G, Phillips, S. Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care. CMAJ. 2008 May 20; 178(11):141825.
122. Diener, HC, Cunha, L, Forbes, C, Sivenius, J, Smets, P, Lowenthal, A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 Nov; 143(12): 113.
123. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996 Nov 16; 348(9038): 132939.
124. Diener, HC, Sacco, RL, Yusuf, S, Cotton, D, Ounpuu, S, Lawton, WA, et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008 Oct; 7(10): 87584.
125. Yusuf, S, Zhao, F, Mehta, SR, Chrolavicius, S, Tognoni, G, Fox, KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001 Aug 16; 345(7): 494502.
126. Diener, HC, Bogousslavsky, J, Brass, LM, Cimminiello, C, Csiba, L, Kaste, M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004 Jul 24-30; 364(9431): 3317.
127. Bhatt, DL, Fox, KA, Hacke, W, Berger, PB, Black, HR, Boden, WE, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006 Apr 20; 354(16): 170617.
128. Chan, FK, Ching, JY, Hung, LC, Wong, VW, Leung, VK, Kung, NN, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med. 2005 Jan 20; 352(3): 23844.
129. Hankey, GJ, Warlow, CP. Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations. Lancet. 1999 Oct 23; 354(9188): 145763.
130. Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001 Sep 29; 358(9287): 103341.
131. Yusuf, S, Teo, KK, Pogue, J, Dyal, L, Copland, I, Schumacher, H, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008 Apr 10; 358(15): 154759.
132. Amarenco, P, Bogousslavsky, J, Callahan, A, 3rd, Goldstein, LB, Hennerici, M, Rudolph, AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 Aug 10; 355(6): 54959.
133. Feasby, TE, Quan, H, Ghali, WA. Hospital and surgeon determinants of carotid endarterectomy outcomes. Arch Neurol. 2002; 59: 187781.
134. Birkmeyer, JD, Stukel, TA, Siewers, AE, Goodney, PP, Wennberg, DE, Lucas, FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003; 349: 211727.

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Carotid Revascularization: An Update

  • Cian J. O'Kelly (a1), Ken S. Butcher (a2), B. Elaine Marchak (a3) and J. Max Findlay (a1)


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