Indication for carotid endarterectomy versus carotid stenting for the prevention of brain embolization from carotid artery plaques: in search of consensus

Stroke is the third leading cause of death and the first cause of disability, which burdens society with the need to supply extensive resources for assistance and rehabilitation. The prevention of stroke has consequently become of utmost importance in modern healthcare. Years ago, several randomized controlled trials (RCT) demonstrated the efficacy of carotid endarterectomy (CEA) in the prevention of stroke in patients with carotid atherosclerosis. 1–4 However, the subsequent introduction of carotid artery stenting (CAS) stressed the need for a critical revision to the management strategy for patients with carotid plaques. One issue that deserves the highest consideration is the indication for treatment. In this article, we analyzed the conventional and emerging parameters used to select surgical or endovascular treatment of carotid artery stenoses, namely, the therapeutic options, risk factors influencing outcome, and evidence supporting various management approaches for patients with carotid disease.