Carotid artery stenting

Summary

Stroke prevention is a major public health priority: the surgical option to treat carotid stenosis, carotid endarterectomy (CEA), has been available for more than 50 years and has been the standard treatment for severe carotid lesions in symptomatic and asymptomatic patients. Carotid artery stenting (CAS) is a more recent and effective endovascular alternative that avoids the invasiveness and morbidity associated with surgery.

Clinical trials have not yet provided clear evidence of the superiority of either treatment for “standard operative risk” patients, and several of them have been criticised for their design, patient selection, and variable physician endovascular training and credentialing requirements.

Solid evidence is still needed in many aspects of CAS, as rapid changes in equipment and techniques create a situation in which clinical practice tends to follow technical developments without the support of adequately powered randomised trials.

Acknowledging the gap in evidence, CAS should be considered as an alternative to surgery only in institutions able to show that their periprocedural complication rates with CAS are equal or lower than with CEA. Preprocedural evaluation of CAS technical risks, use of cerebral protection devices, stent selection and proper management of complications are all key factors in achieving a safe CAS...