Tailored Strategies in Carotid Artery Stenting to Avoid Periprocedural Complications

  • Yusuke EgashiraEmail author
  • Yukiko Enomoto
  • Keita Yamauchi
  • Masanori Tsujimoto
  • Shinichi Yoshimura
  • Toru Iwama
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)


Carotid artery stenting (CAS) has been widely accepted as a valuable therapeutic alternative to carotid endarterectomy (CEA) for high-grade carotid stenosis. Because carotid revascularization including CAS is usually performed in patients with minimal or no neurological deficits, utmost care should be taken to avoid periprocedural complications. The major concerns associated with CAS are embolic stroke, hyperperfusion syndrome (HPS), and perioperative myocardial infarction.

Plaque characteristics, cerebral blood flow (CBF) in the affected cerebral hemisphere, and concomitant coronary artery disease prior to CAS are all important to assess the risks of these complications and are routinely evaluated.

Tailored CAS is planned based on findings of preoperative evaluation, as follows. (1) If the plaque component is thought vulnerable, proximal embolic protection methods, use of a closed-cell-type stent, or referral to CEA should be considered to avoid embolic complications. (2) If patients have severe CBF impairment, staged angioplasty is an effective strategy to prevent postoperative HPS. (3) If concomitant cardiac diseases are present, the optimal treatment sequence should be discussed between cardiologists and neurointerventionalists.

These tailored strategies based on preoperative risk evaluations may lead to safer procedures and better clinical outcome in CAS patients.


Carotid artery stenting Complication Preoperative evaluation Tailored strategy 



Carotid artery stenting


Cerebral blood flow


Carotid endarterectomy


Cerebrovascular reserve


Hyperperfusion syndrome


Magnetic resonance angiography


Magnetic resonance imaging


Percutaneous transluminal angioplasty


Staged angioplasty


Single-photon emission computed tomography




Conflict of Interest

We declare that we have no conflict of interest.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Yusuke Egashira
    • 1
    Email author
  • Yukiko Enomoto
    • 1
  • Keita Yamauchi
    • 1
  • Masanori Tsujimoto
    • 1
  • Shinichi Yoshimura
    • 2
  • Toru Iwama
    • 1
  1. 1.Department of NeurosurgeryGifu University Graduate School of MedicineGifuJapan
  2. 2.Department of NeurosurgeryHyogo College of MedicineNishinomiyaJapan

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