Peer Reviewed
Feature Article Stroke

Stroke-prone patients: focus on carotid surgery and stenting

Peter L Field
An updated version is available in the linked supplement
Abstract

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.