Current indications and problems of CEA and CAS

Various randomized controlled trials have been conducted with regard to the effectiveness of surgical treatment for carotid artery stenosis. Carotid endarterectomy (CEA) was compared to best medical treatment since the 1990s, and carotid artery stenting (CAS) was then compared to CEA since the 2000s. These trials proved the effectiveness of both CEA and CAS especially for the symptomatic patients with high-grade stenosis. However, it is important to validate the necessity of surgical treatment in the asymptomatic patients in this era of developed medical management. In the future, it is necessary to establish the risk factors of each surgical treatment to clarify the appropriate surgical indications. It is also important to develop educational system for surgeons involved in both treatment strategies to improve the overall surgical outcomes.