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STATE-OF-THE-ART PAPER
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Levy et al.
Optimal Treatment of Carotid Artery Disease
Levy et al.
Optimal Treatment of Carotid Artery Disease
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Levy et al.
Optimal Treatment of Carotid Artery Disease
Levy et al.
Optimal Treatment of Carotid Artery Disease
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Conclusions
Carotid artery stenting is continually developing into a safer
and more efficacious therapy for extracranial carotid artery
stenosis. The greater weight of the evidence, as confirmed in
a Cochrane review (86), suggests no significant difference
between CAS and CEA. However, CAS is still a burgeoning technology with many questions still needing to be
answered. Future clinical research should address many of
these questions. As we move towards the future, the
question posed should now be what is the optimal treatment for carotid artery stenosis in this patient? not what is
the optimal treatment for carotid artery stenosis? Endovascular physicians must rigorously apply the lessons learned
from previous well-designed trials to avoid treating patients
who are at higher risk for complications with CAS. Continued enrollment in rigorously randomized trials such as
CREST will provide a great deal of insight into such
patient-specific risk factors. The use of CAS and CEA as
complementary therapies, while optimizing current medical
treatments, will provide the greatest likelihood of minimizing poor patient outcomes.
Reprint requests and correspondence: Dr. Elad I. Levy, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, 3
Gates Circle, Buffalo New York 14209. E-mail: elevy@buffns.com.
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