Selection of patients for carotid intervention

Although only a minority of patients with TIA or ischemic stroke are potential candidates for carotid endarterectomy (CEA) or stenting, the decision to opt for interventional treatment rather than medical treatment alone can be difficult and is, therefore, given detailed consideration in this Ch. Most of the discussion relates to CEA because far more data are available on the risks and benefits of surgery than for stenting. However, most of the issues discussed are applicable to both procedures. 

As well as being related to the skills of the surgeon and anesthetist and aspects of the surgical technique, the operative risk of stroke and death also depends on patient age and sex the nature of the presenting event coexisting pathology, such as coronary heart disease and several other factors (Table 27.1). 

Vascular risk factors previous stroke, hypertension, diabetes, contralateral internal cerebral artery occlusion, peripheral vascular disease 

Presenting event Time period Number of studies Number of operations Absolute risk (% [95% Cl]) p value (heterogeneity) 

confidence interval TIA, transient ischemic attack. Source From Bond et al. (2003). 

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