Myocardial risk in carotid endarterectomy and stenting

Carotid stenosis is an important cause of ischaemic stroke. Carotid endarterectomy (CEA) reduces the risk of stroke among patients with symptomatic and asymptomatic carotid stenosis. Stent treatment has emerged as an alternative to surgery but is associated with a higher risk of periprocedural stroke. Randomised trials have yielded conflicting results regarding the risk of myocardial infarction (MI) with stenting and CEA. These differences are mostly explained by differences between trials in study populations, as well as assessment and definition of MI. Considering all available randomised trial data, periprocedural MI is more common with CEA than with stent treatment. As with periprocedural stroke, periprocedural MI also leads to a decrease in long-term survival. Thus, MI must be regarded a serious adverse event complicating carotid interventions. Stent treatment therefore represents an alternative to CEA among patients with clear indication for carotid revascularisation who are considered at increased risk for coronary events.