Vaskulárna medicína 1/2026
Seventy-five years of carotid reconstruction: from surgical pioneering to evidence-based medicine
Carotid endarterectomy (CEA) represents, over seventy-five years of development, a paradigmatic example of how evidence accumulates for a surgical procedure. This article traces that evolution from the first pioneering operations of the 1950s — Carrea (1951), DeBakey (1953), Eastcott et al. (1954) — through an era of uncontrolled expansion with alarming complication rates (combined stroke/mortality 21.1% in community hospitals), to definitive evidence from the NASCET (1991, absolute risk reduction 17%, NNT = 6) and ECST (1991) randomized trials. The development of carotid artery stenting (CAS) in the 1990s followed a similar pattern of adoption without robust evidence. SPACE and EVA-3S (2006) failed to validate CAS, while CREST (2010) achieved statistical equivalence only by including myocardial infarction in the composite endpoint. A pooled analysis of four randomized controlled trials (2019) confirmed that the periprocedural advantage of CEA (~3.2%) persists throughout the entire 9-year follow-up. ESVS 2023 guidelines confirm CEA as the gold standard (Class I, Level A) for symptomatic stenosis ≥ 70%. Transcarotid artery revascularization (TCAR) represents a technologically promising but as yet randomized-trial-unvalidated approach.
Keywords: carotid endarterectomy, carotid artery stenting, NASCET, ECST, TCAR, history of vascular surgery
