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Editorials

Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery

Dogma Debunked?

John R. Laird, MD and William C. Pevec, MD

From the Department of Medicine (J.R.L.), Division of Cardiovascular Medicine, and Department of Surgery (W.C.P.), Division of Endovascular and Vascular Surgery, Vascular Center, University of California Davis Medical Center, Sacramento, Calif.

Correspondence to John R. Laird, MD, Department of Medicine, Division of Cardiovascular Medicine, UC Davis Vascular Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 3400, Sacramento, CA 95817. E-mail john.laird@ucdmc.ucdavis.edu

Key Words: carotid arteries • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 1954, Eastcott et al¹ opened the era of the surgical treatment of carotid atherosclerosis. In the ensuing 54 years, much has been learned about the benefits of carotid endarterectomy (CEA) for the treatment of symptomatic and asymptomatic carotid artery stenosis. Recently, carotid artery stenting has gained acceptance as a reasonable alternative to CEA for patients who are deemed at high risk for complications from surgery.² Despite all of the advancements in the techniques of carotid artery revascularization, little progress has been made in the treatment of chronic total occlusion.

Article see p 119

Through extensive personal experience, the early leaders of vascular surgery defined the parameters for carotid surgery. In 1965, De Bakey³ first highlighted the challenges associated with the treatment of internal carotid artery occlusion when he pointed out that "because of intracranial extension of the thrombotic process and its organization, the incidence of restoration of circulation for complete occlusion at (the internal carotid artery) declined sharply after 24 hours." In 1970, Thompson et al⁴ published a landmark series of 592 patients undergoing CEA that included 118 totally occluded internal carotid arteries. In this subgroup, flow was restored in only 41%, with a mortality of 6.2%. Thompson concluded that "the patient with a totally occluded carotid artery should not be routinely operated on nor should he be categorically rejected for operation."

When doubts arose in the 1980s about the benefits of CEA,^5,6 prospective, randomized trials were organized to compare the results of CEA with medical management for the . . . [Full Text of this Article]

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