The Evolution of Carotid Surgery

This review traces the evolution of carotid surgery from its ancient roots to modern practice. The first significant appreciation of the carotid arteries' role in cerebral ischemia was made by Johann Jakob Wepfer in his 1,658 book on apoplexy, which described the separate blood supply to each cerebral hemisphere by the carotid arteries. The 16th-19th centuries saw initial attempts at carotid ligation, while the 20th century marked significant advancements. The first carotid endarterectomy (CEA) by DeBakey, Cooley, and Eastcott in the 1950s paved the way for a new technique in carotid surgery and many subsequent refinements in surgical techniques related to CEA. The latter half of the 20th century brought innovations, such as patch angioplasty, microsurgical techniques, and intraoperative shunting, significantly improving outcomes. Pivotal clinical trials established CEA as the standard treatment for symptomatic carotid stenosis. The emergence of carotid artery stenting (CAS) in the 1980s introduced a less invasive alternative, sparking ongoing debates about optimal treatment strategies. Recent developments include transcarotid artery revascularization (TCAR) and transfemoral CAS, with studies comparing their efficacy to traditional CEA. Current research focuses on plaque morphology and novel diagnostic factors to further personalize treatment strategies for carotid artery stenosis.