Comparison of carotid endarterectomy, carotid stenting and current best medical treatment in patients with moderate asymptomatic carotid stenosis

摘要

Introduction: Best treatment for asymptomatic moderately stenotic carotid stenosis is still controversial (1). Some evidence suggests that current best medical treatment alone is sufficient for asymptomatic carotid stenosis and that no intervention is required. Recent evidence indicates that the risk of ipsilateral and any territory stroke or TIA in hospital identified, non-operated patients with asymptomatic severe carotid stenosis has fallen significantly over the last 25 years (2). The most recent measures of average annual rate of ipsilateral stroke ranged from 0.6-1.7%. These annual stroke rates are statistically not different from those patients who received invasive treatment (surgery or stenting) in the large randomized carotid surgery (CEA) or carotid stenting (CAS) trials; the asymptomatic carotid surgery trial (ACST) and CREST (3,4). The implication is that invasive treatment (CEA or CAS) no longer offers any significant stroke prevention benefit in comparison to current best medical treatment (BMT) alone (5,6). The aim of this study was to compare in case control study the five year outcome of patients presenting with asymptomatic carotid stenosis who were treated with carotid endarterectomy (CEA), carotid artery stenting (CAS) and current best medical treatment alone.