The surgical treatment of carotid artery disease: carotid endarterectomy vs. carotid artery stenting.

Carotid artery stenosis from atherosclerotic plaque remains one of the leading causes of stroke. Therapy for this condition includes carotid endarterectomy (CEA) and carotid artery stenting (CAS). Achieving appropriate care for patients with carotid stenosis demands an understanding of these two revascularisation procedures. While early research has shown that CEA represents a safer alternative to CAS, recent research reflects a more nuanced comparison between the two revascularisation procedures. Up to one year after revascularisation, several randomised controlled studies (including EVA-3S, the ICSS, and CREST) have shown that CAS represents a higher risk of stroke than CEA. However, it is unclear if there is a difference in the severity and complications of stroke that may occur after either procedure. Beyond one year post revascularisation, the differences between the two procedures appear to be far less pronounced, if present at all. Considering this data, physicians should focus on age and other risk factors for stroke or myocardial infarction when deciding on the most appropriate revascularisation procedure for their patients.