Carotid Artery Angioplasty and Stenting

Stroke represents a significant source of mortality and morbidity worldwide and is the fifth leading cause of death in the United States. Atherosclerotic disease of the carotid vessels is responsible for up to 16% of all ischemic strokes. The gold standard of management for severe carotid stenosis, especially when symptomatic has been carotid endarterectomy, an open surgical procedure. In recent years, carotid angioplasty and stenting have been developed as an alternative and minimally invasive technique for treating carotid disease. Numerous trials have been conducted to compare outcomes of carotid stenting versus endarterectomy which have largely shown that carotid stenting is not inferior to carotid endarterectomy. Embolic protection techniques, including filters and flow-reversal technology have continued to make carotid stenting a safer procedure. At present, carotid stenting is approved for use in patients who are at high risk for carotid endarterectomy either due to medical comorbidities or anatomy. However, there are a number of anatomic requirements which must be met in order to safely perform carotid stenting. Ongoing developments in technology as well as continued clinical studies will likely continue to further define the scope of carotid stenting.