Feature Article

Stroke-prone patients: focus on carotid surgery and stenting

Peter L Field
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Carotid endarterectomy effectively reduces the risk of stroke. Will carotid artery stenting prove to be as effective, and any safer?

Key Points

  • Transient cerebral symptoms and neck bruits are the key warnings of immediate stroke risk. A TIA is a cerebral emergency – start aspirin, and investigate promptly.
  • Although atheroembolism from unstable carotid plaques is a frequent cause of stroke, carotid stenosis guides patient selection for surgical intervention.
  • In the last decade, imaging of carotid disease by duplex ultrasound studies and angiography has improved in detail and safety.
  • Carotid endarterectomy provides evidence-based stroke prevention in selected patients.
  • Carotid artery stenting is a percutaneous alternative to open operation but is on trial; currently, its efficacy is unproven and it carries significant risks.
  • Modern stroke prevention combines surgical intervention (both open and endovascular carotid surgery) with the medical management of multiple risk factors for stroke, such as hyperlipidaemia, hypertension and hyperviscosity.