Carotid Angioplasty and Stenting

The relative indications for CAS versus CEA have not been determined. Whereas endarterectomy remains the gold standard for the treatment of significant carotid artery stenosis, early results suggest that angioplasty and stenting may be indicated in selected patients with risk factors for complications from endarterectomy. Despite involving vastly different mechanisms for treatment of atherosclerotic lesions, permanent neurologic morbidity and mortality rates for both techniques are similar. The transient or minor neurologic events seen more often with CAS may be amenable to prevention with distal protection techniques currently undergoing clinical testing. With careful preprocedural evaluation of medical comorbidities, appropriate treatment with antiplatelet agents, and careful evaluation of the target lesion, most potential complications of angioplasty and stenting may be avoided or at least anticipated. Further technical advancements in endovascular therapy and patient-driven preferences for less-invasive procedures are likely to expand the indications and applications of CAS.