Carotid artery stenosis treatment [Neurosurgery Wiki]

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====== Carotid artery stenosis treatment ======

It is important to assess risks for CEA carefully including anatomical factors and comorbidities and to elaborate each strategy for each operation based on preoperative imaging studies including [[carotid artery]] [[ultrasonography,]] [[magnetic resonance imaging]], and [[angiography]]. In surgery, there are many tips on operative position, procedure, shunt usage, and monitoring to perform a safe and smooth operation. Now that [[carotid artery stenting]] has been rapidly developed, a better understanding of CEA is required to treat carotid artery stenosis adequately. 
((Hara T, Rai Y. [[Carotid Endarterectomy]]. [[Adv Tech Stand Neurosurg]]. 2022;44:187-207. doi: 10.1007/978-3-030-87649-4_10. PMID: 35107680.)).
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For symptomatic extracranial [[carotid artery stenosis]] (SECS) patients who cannot undergo early [[carotid endarterectomy]], early carotid artery stenting (CAS) is effective and safe if selectively indicated considering disease severity. Early and delayed CAS provide comparable mRS scores, the incidence of symptomatic thromboembolic complications, and intracranial bleeding with or without cerebral [[hyperperfusion syndrome]] (CHS)
((Yang NR, Jeon P, Kim B, Kim KH, Jo K. Usefulness of Early Stenting for
Symptomatic Extracranial Carotid Stenosis. World Neurosurg. 2016 Sep 15. pii:
S1878-8750(16)30853-1. doi: 10.1016/j.wneu.2016.09.027. [Epub ahead of print]
PubMed PMID: 27641265.
)).

Treatment of CS consists of best medical treatment and carotid revascularization (CR), including carotid endarterectomy (CEA) and [[carotid artery stenting]] (CAS). Both CR techniques have their own procedural risks. Therefore, selection of the appropriate treatment for patients with CS is relatively complicated. Many studies and guidelines have reported the efficacy of each treatment for both symptomatic and asymptomatic patients. However, the results are still controversial, especially concerning the efficacy and safety of CEA and CAS
((Noiphithak R, Liengudom A. Recent Update on Carotid Endarterectomy versus
Carotid Artery Stenting. Cerebrovasc Dis. 2016 Nov 30;43(1-2):68-75. [Epub ahead 
of print] PubMed PMID: 27898402.
)).

===== Carotid artery stenting =====

see [[Carotid artery stenting]] (CAS).

===== Carotid endarterectomy =====

see [[Carotid endarterectomy]] (CEA).