Past, present and future of carotid artery stenting: a critical review of randomized studies and registries

Carotid endarterectomy (CEA) has been the standard of care in primary and secondary stroke prevention following the publication of seminal trials comparing CEA to medical therapy for both symptomatic and asymptomatic patients determined to require revascularization. In recent years, carotid artery stenting (CAS) has emerged as a potential alternative to CEA, as it is less invasive and associated with less surgically related morbidity and the potential for an accelerated convalescence. A large body of literature, including randomized clinical trials and real-world registries, has attempted to compare the safety and efficacy of CAS with that of CEA. Unfortunately, despite the wealth of data, studies have been, for the most part, conflicting and inconclusive. What appears clear is that CAS provides long-term stroke prevention equal to surgery at least to 4 years, and is a reasonable alternative to CEA in patients regardless of surgical risk or symptomatic status in the hands of experienced operators. After t...