Carotid artery stenting

Updated on May 12, 2016
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Summary

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

Clinical trials have not yet provided clear evidence of superiority of either treatment for “standard operative risk” patients and have been criticized for their design, patient selection, and very variable physician training and credentialing.

Solid evidence is still needed in many aspects of the management of CAS: we are aware that in the field of this specific interventional therapy, rapid changes in available therapeutic techniques create the situation in which clinical practice tends to follow technical developments without evidence from well-designed randomized trials.

In this gap of clear evidence, carotid artery stenting can be an alternative to surgery only if the peri-procedural complications are equal or less than the ones related to carotid endarterectomy. From this perspective, preprocedural evaluation of CAS technical risks, use of cerebral protection devices, stent selection and proper management of CAS complications are all key-points for managing...

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