Medical, Surgical, and Interventional Treatment of Extracranial Internal Carotid Artery Disease

Abstract

Stroke is one of the leading causes of death in many countries. Carotid endarterectomy (CEA) is the gold standard treatment to reduce stroke risk in patients with significant carotid disease proving its efficacy over medical therapy, however, CEA has limitations and various complications such as; those not of atherscelerotic nature, perioperative myocardial infarction, stroke, recurrent stenosis after CEA, cranial nerve injury and wound problems. Carotid angioplasty and stentiilg has recently emerged as an alternative to CEA in treating lesions of the carotid artery and became increasingly popular. Although, still under intense investigation, it is already clear that endovascular therapy of the carotid artery is effective in the correction of lesions not readily accessible by surgery. Technological advances in catheters and wires have made access to the extracranial carotid circulation safer and faster than ever before. Although liberation of emboli remaining the most feared of carotid stenting complications, meticulous technique, and, in the future distal protective devices will likely minimize this complication and diminish peri procedural morbidity caused by stroke and will result in marked decline in its occurrence.