Symptomatic carotid stenosis: endarterectomy, stenting, or best medical management?

In the past, management of symptomatic carotid stenosis was uncertain. The results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) in 1991 demonstrated a significant advantage of Carotid Endarterectomy (CEA) compared to medical management with Aspirin (ASA). Since the publishing of the NASCET results, there have been advances in both the medical management of patients with peripheral arterial disease as well as the introduction and improvement of the technique of minimally invasive carotid angioplasty and stenting. With this progress, the question has to be raised about what is the most appropriate treatment option for patients with symptomatic carotid artery stenosis. A review of the prospective clinical trials regarding the medical, surgical and endovascular management will help to elucidate the optimal therapy for symptomatic carotid stenosis.