Surgical Treatment for Carotid Stenosis: Carotid Endarterectomy

Although the 2009 guidelines for the treatment of cerebrovascular disease indicate carotid endarterectomy (CEA) as a first-line treatment for patients with carotid stenosis, carotid stenting (CAS) has been performed about twice as often as CEA. Reasons for this finding may include: 1) a lack of surgeons familiar with CEA; 2) scarcity of teaching systems for CEA; and 3) medical or social tendencies toward performing less invasive surgery. However, the number of CEA surgeries has not decreased over the last decade. Indications for CEA or CAS should be determined according to the condition of the patient and the technical skills of the surgeon. Favorable factors for CEA include: 1) unstable plaque; 2) plaque with ulcer; 3) plaque with floating thrombus; 4) plaque with severe calcification; 5) excessively tortuous access route; 6) patients who are considered at excessive risk of needing to stop antiplatelet therapy in the future. To keep CEA as an effective surgical option, surgeons should perform CEA with a complication rate ＜3% and a low restenosis rate, and should create teaching systems for CEA surgeons.