In the management of vascular disease, there has been an inexorable drive towards less invasive endovascular treatments. This has substantially altered the attitudes of patients, clinicians and health care providers.
Endovascular treatment of carotid stenosis for stroke is no exception. Several trials are running concurrently; these are comparing carotid endarterectomy (CEA) with the less invasive alternative, carotid stenting (CAS). There is already evidence that CAS may be preferable in certain patient populations i.e. those deemed to be at high surgical risk. Furthermore both procedures have comparable benefits in terms of survival free of ipsilateral stroke between three to five years post-procedure.
State-of-the-art CAS (with regards use of all available technical refinements) is all but five years old. There is considerable interest from clinicians from a variety of clinical backgrounds and from industry in this technique and, therefore, scope for a contemporary practical guide.
About the Author: Gerard P Stansby, BA, MBBChir, MA, FRCS, MChir, is a Professor of Vascular Surgery, Freeman Hospital and University of Newcastle upon Tyne, UK. He is an experienced editor of several books and journals and has published books on surgery and venous diseases (Goldberg & Stansby, Surgical Talk; Surgery for Finals, World Scientific Book Publishing, 1999 ISBN 1-86094-077-3 "2nd edition 2005; Belcaro, Nicolaides, & Stansby, The Venous Clinic, Imperial College Press.1997, ISBN 1-86094-051-X; Labropoulos & Stansby, Venous and Lymphatic Diseases, Marcel Dekker ltd. 2006, ISBN 0824729234). He is a consultant vascular surgeon, experienced in carotid surgery and patient selection. He has published research on carotid surgery and is the author of the Royal College of Surgeons STEP course section on carotid disease.
Sumaira Macdonald, MBChB, MRCP, FRCR, PhD, is a Consultant Vascular Radiologist & Honorary Clinical Senior Lecturer, The Freeman Hospital, Newcastle upon Tyne, UK, who has been responsible for setting up the carotid stenting program in Newcastle. She is also involved with several trials of carotid stenting, and regularly proctors and teaches the technique nationally and internationally.
