CONTEMPORARY MANAGEMENT OF CAROTID ARTERY STENOSIS: EVALUATING CEA, TRANSFEMORAL STENTING, TCAR, AND BMT
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.6019Keywords:
Carotid Artery Stenosis, Stroke Prevention, Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS), Transcarotid Artery Revascularization (TCAR), Best Medical Therapy (BMT), Atherosclerosis, NeuroprotectionAbstract
Carotid artery stenosis causes 10% to 20% of all strokes. This review evaluates the evolving, complementary roles of carotid endarterectomy (CEA), transfemoral stenting (TFCAS), transcarotid revascularization (TCAR), and best medical therapy (BMT). Aggressive BMT forms the universal foundation of care, reserving intervention for symptomatic (≥50%) or high-risk asymptomatic (>70%) patients. CEA remains a durable gold standard where routine patch angioplasty minimizes perioperative stroke and thrombosis. While traditional TFCAS carries elevated stroke risks in patients over 70, modern dual-layer stents and proximal protection significantly mitigate microembolic complications. TCAR successfully bridges open and endovascular approaches; by utilizing direct access and neuroprotective flow reversal, it minimizes embolic and cranial nerve injuries while providing the highest probability of preventing long-term restenosis. Ultimately, modern management has transitioned from competing modalities into a highly individualized selection paradigm.
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Copyright (c) 2026 Jonatan Rataj, Paweł Budzik, Szymon Marciszuk, Agata Kaczmarzyk, Michał Zaborowski, Klaudia Purgał-Zaborowska, Aleksandra Arczewska
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