- Indications to CEA:
- CEA is of proven benefit for symptomatic patients with
75% to 99% stenosis.
- Consider in symptomatic patients with
- Greatest clinical benefit if done with 14 days of the last symptomatic event
- Contraindication to CEA:
- 100% carotid stenosis
- Previous stroke with persistent neurologic symptoms
- Poor surgical candidate
- Hx of recent MI are at greatly increased risk for both
cerebrovascular and cardiovascular complications of vascular
- Hx of ionizing radiation to the neck in the area of the carotid
bifurcation increases the rate of complications.
- The presence of a tracheal stoma makes carotid endarterectomy
technically difficult and increases the complication rate.
- Angioplasty with stenting:
- At this time, symptomatic patients who are at high risk
for perioperative complications of CEA or who have
characteristics that make CEA technically difficult may be
candidates for angioplasty with stenting.
- Although patients with diabetes mellitus are at increased risk
for cerebrovascular disease and complications of surgery, the risk
is moderate and carotid endarterectomy (CEA) has been proven to be a
beneficial intervention in this population.
- 3 trials (NASCET, ECST, VA) benefits of CEA best in:
- Men > women
- Age > 75
- Recent minor stroke (vs TIA)
- Presence of hemispheric symptoms (not amaurosis fugax)
- Early surgery (within 2 weeks of TIA)
- Note: These studies done prior to era of widespread
aggressive medical therapy AHA, American Stroke Association, 2006