Clinical Challenge in Surgery – Carotid Artery Stenosis

Carotid endarterectomy is a great option for most patients, but what do you do when the lesion extends high in the neck or the neck has been irradiated? In this episode from the Vascular Surgery team at Behind the Knife, we discuss carotid artery stenosis using a real patient case from the University of Michigan. We touch on diagnosis and imaging as well as medical and surgical management of carotid disease with a special discussion about Transcarotid Artery Revascularization (TCAR), a new technique available for the treatment of carotid lesions.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Seminal Papers in Carotid Artery Stenosis

The MRC European Carotid Surgery Trial (ECST): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext

Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS Trial): https://jamanetwork.com/journals/jama/article-abstract/388335

The North American Symptomatic Carotid Endarterectomy Trial (NASCET Trial): https://www.ahajournals.org/doi/epub/10.1161/01.STR.30.9.1751

Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER Trial): https://pubmed.ncbi.nlm.nih.gov/26506270/

ROADSTER 2 Trial: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030550