J Cerebrovasc Endovasc Neurosurg.  2015 Jun;17(2):101-107. 10.7461/jcen.2015.17.2.101.

A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis

• Jang EW
• Chung J
• Seo KD
• Suh SH
• Kim YB
• Lee KY

• KMID: 1879341
• DOI: http://doi.org/10.7461/jcen.2015.17.2.101

Abstract

OBJECTIVE
There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis.
MATERIALS AND METHODS
A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established.
RESULTS
CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected.
CONCLUSION
We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.

Keyword

Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Protocol

MeSH Terms

Carotid Arteries
Carotid Stenosis*
Constriction, Pathologic
Endarterectomy, Carotid
Humans
Stents

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