Evidence-Based Approach to Carotid Atherosclerotic Disease: Medicine, Surgery, or Stent?
Colin Derdeyn, M.D. -- Associate Professor of Radiology, Neurology and Neurological Surgery
Washington University School of Medicine -- Presented August 16, 2005


Introduction

This lecture reviews the published data supporting the use of carotid endarterectomy and angioplasty and stenting, relative to each other and best medical therapy (aspirin for most of the trials) in patients with symptomatic and asymptomatic atherosclerotic extracranial carotid artery stenosis. Recent published and unpublished data on medical and endovascular treatment for patients with symptomatic intracranial atherosclerotic stenosis are briefly reviewed.

Click here to begin


References

Practical considerations in the early treatment of ischemic stroke.
Broderick JP.
Am Fam Physician. 1998 Jan 1;57(1):73-80.

Thirty-year projections for deaths from ischemic stroke in the United States.
Elkins JS, Johnston SC.
Stroke. 2003 Sep;34(9):2109-12.

Cardiac and arterial lesions in carotid transient ischemic attacks.
Bogousslavsky J, Hachinski VC, Boughner DR, Fox AJ, Vinuela F, Barnett HJ.
Arch Neurol. 1986 Mar;43(3):223-8.

Carotid disease in acute stroke.
Mead GE, Shingler H, Farrell A, O'Neill PA, McCollum CN.
Age Ageing. 1998 Nov;27(6):677-82.

Multigated Doppler ultrasound in the detection of emboli in a flow model and embolic signals in patients.
Molloy J, Markus HS.
Stroke. 1996 Sep;27(9):1548-52.

Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.
Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ.
JAMA. 1998 Sep 23-30;280(12):1055-60.

Cerebral hemodynamics and risk for recurrent stroke in symptomatic internal carotid artery occlusion.
Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Shio H.
Rinsho Shinkeigaku. 1999 May;39(5):513-9.

Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis.
Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Caltagirone C.
JAMA. 2000 Apr 26;283(16):2122-7.

Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study.
Ogasawara K, Ogawa A, Yoshimoto T.
Stroke. 2002 Jul;33(7):1857-62.

European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke.
Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A.
J Neurol Sci. 1996 Nov;143(1-2):1-13.
Stroke Trials Directory Entry: ESPS-2

Comparative safety and tolerability of clopidogrel and aspirin: results from CAPRIE. CAPRIE Steering Committee and Investigators. Clopidogrel versus aspirin in patients at risk of ischaemic events.
Harker LA, Boissel JP, Pilgrim AJ, Gent M.
Drug Saf. 1999 Oct;21(4):325-35.
Stroke Trials Directory Entry: CAPRIE

A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.
Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, Kistler JP, Albers GW, Pettigrew LC, Adams HP Jr, Jackson CM, Pullicino P; Warfarin-Aspirin Recurrent Stroke Study Group.
N Engl J Med 2001 Nov 15;345(20):1444-51.
Stroke Trials Directory Entry: WARSS

Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators.
N Engl J Med 1991 Aug 15;325(7):445-453.
Stroke Trials Directory Entry: NASCET

The practice of carotid endarterectomy in a large metropolitan area.
Brott T, Thalinger K.
Stroke. 1984 Nov-Dec;15(6):950-5.

Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.
Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD.
N Engl J Med 1998 Nov 12;339(20):1415-25.
Stroke Trials Directory Entry: NASCET

Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis.
Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists' Collaboration.
Lancet. 2003 Jan 11;361(9352):107-16.

Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration.
Lancet. 2004 Mar 20;363(9413):915-24.

Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.
Lancet 2001 Jun 2;357(9270):1729-37.
Stroke Trials Directory Entry: CAVATAS

Protected carotid-artery stenting versus endarterectomy in high-risk patients.
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators.
N Engl J Med. 2004 Oct 7;351(15):1493-1501.
Stroke Trials Directory Entry: SAPPHIRE

Carotid Revascularization Endarterectomy vs Stent Trial
Stroke Trials Directory Entry: CREST

Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischemic attack and nondisabling stroke.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ.
Stroke. 2004 Dec;35(12):2855-61.

Long-term outcome after angioplasty for symptomatic extracranial carotid stenosis in poor surgical candidates.
Fox DJ Jr, Moran CJ, Cross DT 3rd, Grubb RL Jr, Rich KM, Chicoine MR, Dacey RG Jr, Derdeyn CP.
Stroke. 2002 Dec;33(12):2877-80.

Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group.
N Engl J Med. 1985 Nov 7;313(19):1191-1200.
Stroke Trials Directory Entry: EC/IC Bypass Study

Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.
Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ.
JAMA. 1998 Sep 23-30;280(12):1055-60.

Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects.
Powers WJ, Martin WR, Herscovitch P, Raichle ME, Grubb RL Jr.
Neurology. 1984 Sep;34(9):1168-74.

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans
Y Samson, JC Baron, MG Bousser, A Rey, JM Derlon, P David, and J Comoy
Stroke 1985 16: 609-616.

Cerebral haemodynamic changes after extracranial-intracranial bypass surgery.
Gibbs JM, Wise RJ, Thomas DJ, Mansfield AO, Russell RW.
J Neurol Neurosurg Psychiatry. 1987 Feb;50(2):140-50.

Cerebral hemodynamics and risk for recurrent stroke in symptomatic internal carotid artery occlusion.
Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Shio H.
Rinsho Shinkeigaku. 1999 May;39(5):513-9.

Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST)
Lancet. 1998 May 9;351(9113):1379-87.
Stroke Trials Directory Entry: ECST

Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
JAMA 1995 May 10;273(18):1421-1428.
Stroke Trials Directory Entry: ACAS

Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group.
Lancet 2004; 363: 1491-1502.
Stroke Trials Directory Entry: ACST

Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial.
Rothwell PM, Goldstein LB.
Stroke. 2004 Oct;35(10):2425-7.

Benign prognosis of never-symptomatic carotid occlusion.
Powers WJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Grubb RL Jr.
Neurology. 2000 Feb 22;54(4):878-82.

Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis.
Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chaturvedi S, Kasner SE, Benesch CG, Sila CA, Jovin TG, Romano JG; Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators.
N Engl J Med. 2005 Mar 31;352(13):1305-16.
Stroke Trials Directory Entry: WASID

Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results.
SSYLVIA Study Investigators.
Stroke. 2004 Jun;35(6):1388-92.
Stroke Trials Directory Entry: SSYLVIA

 

Internet Stroke Center at Washington University:
Copyright © 1997 -2007 All rights reserved.