Current issues in carotid endartrectomy

초록

Major goal of carotid endartrectomy is to reestablish the carotid flow safely and to remove the risk of future stroke in vulnerable stroke patients. Carotid endarterectomy has been improved continuously in its technical aspect since it had been introduced as an effective treatment option in 1950s and. Although highly effective, there are some limitations and issues, which are controversial still. When we select surgical candidates, primary considering factors are related to symptoms and degree of carotid stenosis. Many surgeons agree to do carotid endarterectomy (CEA) for symptomatic lesion with severe degree of stenosis, but benefits of CEA seem to be very small in nonsymtomatic lesions, even if they have severe degree of stenosis. Then, patient selection in the non symptomatic lesion can always be a debate topic. Of course, selection of patients can be an issue in the symptomatic lesion because there are many factors, that should be considered, such as the extent of recent infarction, surgical timing in patients with recent stroke and co existence of intracranial aneurysin or coronary artery occlusive disease. Selection of treatment method is another issue. Although many results of clinical trials about CEA and CAS (carotid artery stenting) have been reported, we can enjoy debate still in the method selection. Many parameters, such as cardiac morbidity mortality, bright spot in DWI (diffusion weighted image), and restenosis rate are using for secondary evaluation of method effectiveness and safety. We can get a different result from different parameters. Which parameters should be included in assessment of treatment methods? Discuss will be needed to know whether there is different indication for each procedure or parallel competition between CEA and CAS is still ongoing. Anesthetic big issue is in cerebral protection during carotid clamping. Dose cerebral protection with high-dose Pentothal under the burst suppression works really? Does bypass shunt increase th