Treatment for cervical carotid artery stenosis using evidenced-based medicine

While cervical carotid stenosis should be essentially treated with anti-thrombotic drugs, carotid endarterectomy (CEA) or carotid artery stenting (CAS) may be performed for such lesions when definite criteria are met. These criteria have been determined through several large controlled randomized trials. The benefit of CEA has been established by NASCET, ECST, ACAS, and ACST. The SAPPHIRE trial showed the non-inferiority of CAS compared to CEA in patients with high-risk factors for CEA. However, SPACE, EVA-3S, and ICSS failed to show this non-inferiority in patients without high risk factors for CEA. CREST, the most recent trial, has demonstrated that CAS and CEA are equally effective. In conclusion, CEA is the treatment of choice for patients with severe asymptomatic or symptomatic carotid artery stenosis. CAS should be performed for patients with severe carotid artery stenosis only when they have high-risk factors for CEA.