From the Guidelines
Carotid endarterectomy (CEA) is the recommended treatment for a 79% stenosed internal carotid artery.
Treatment Options
- CEA is the preferred treatment for patients with symptomatic severe (70% to 99%) carotid stenosis, as it has been shown to be effective in reducing the risk of stroke and death 1.
- Carotid artery stenting (CAS) may be considered as an alternative to CEA for symptomatic patients at average or low risk of complications associated with endovascular intervention, but it is generally not recommended for patients over 70 years old due to a higher peri-procedural risk of stroke and death 1.
Key Considerations
- The degree of stenosis should be measured by CTA to guide surgical decision-making 1.
- Perioperative morbidity and mortality risk should be estimated to be less than 6% for CEA to be recommended 1.
- Patient age is an important factor in selecting the treatment, with CEA favored for elderly patients 1.
- Optimal medical therapy, including antiplatelet therapy, statin therapy, and risk factor modification, should be recommended for all patients with carotid artery stenosis and a TIA or stroke 1.
From the Research
Treatment Options for 79% Stenosed Internal Carotid Artery
The treatment for a 79% stenosed internal carotid artery can be either carotid endarterectomy (CEA) or carotid artery stenting (CAS).
- Carotid endarterectomy is a surgical procedure that removes the plaque buildup in the carotid artery to improve blood flow to the brain 2.
- Carotid artery stenting is a minimally invasive procedure that uses a stent to keep the carotid artery open, improving blood flow to the brain 3.
Considerations for Treatment
The choice of treatment depends on various factors, including the patient's overall health, medical history, and the severity of the stenosis.
- For patients with symptomatic carotid stenosis, CEA or CAS can reduce the risk of stroke or death 2, 3.
- For patients with asymptomatic carotid stenosis, the decision to perform CEA or CAS should be based on individual patient characteristics and the presence of other medical conditions 4.
Risks and Benefits of Treatment
Both CEA and CAS carry risks and benefits that should be carefully considered.
- CEA has been shown to reduce the risk of stroke or death in patients with severe carotid stenosis, but it also carries a risk of operative complications 2.
- CAS is a safer alternative to CEA for some patients, but it may not be suitable for all patients, especially those with complex anatomy or severe stenosis 3.
- The management of severe bilateral symptomatic internal carotid artery stenosis is controversial, considering the reported high risk of periprocedural stroke, hemodynamic distress, and cerebral hyperperfusion syndrome 5.