Carotid Artery Stenosis: Current and Emerging Treatments PDF

Preface

Carotid artery stenosis (CAS) is a major cause of ischemic stroke. Each year in the US and Europe alone, there are nearly two million strokes and CAS is estimated to account for up to 20% of these events. Carotid disease is also a leading cause of transient ischemic attacks or ‘‘mini-strokes'', and is likely to be an increasingly important public health problem in both the developed and developing worlds as populations age.

For the last three decades, treatment of patients with CAS has involved medical therapy with antithrombotics, lipid-lowering and blood pressure-lowering drugs in most patients and surgical treatment with carotid endarterectomy (CEA) in some. However, in recent years medical treatments have improved and there has been increasing interest in carotid artery stenting as a possible alternative to conventional surgery. Several randomized trials of stenting are ongoing or have recently been completed and there have been advances in catheter design and distal protection devices. Surgical treatment is also changing with increased use of local anesthesia and new data on the risks and benefits of ancillary techniques, such as routine patching and synthetic grafts. Of equal importance, our understanding of which patients are most at risk of stroke without treatment and therefore have the most to gain from timely intervention is also advancing.

A multidisciplinary book, summarizing the latest evidence on optimal medical, surgical, and intravascular interventional treatment of CAS, as well as recent advances in our understanding of its epidemiology, pathology, and imaging, is therefore required. The goal of this book is to provide a ‘‘state of-the-art'' review of all of these areas, with particular emphasis on the latest evidence about treatment.We are therefore indebted to all of our co-authors and colleagues who have helped us to achieve this goal by providing comprehensive reviews of the ‘‘state of the art'' in their particular clinical and research specialties.

We hope that this book will be of interest to all healthcare professionals who are involved in the management of patients with CAS, including neurologists, vascular surgeons, neurosurgeons, neuroradiologists, general interventional radiologists, and internists. Ultimately, we hope that patients will benefit from the application in routine clinical practice of the advances outlined in this book and that it will stimulate further research into the many questions that still remain unanswered.