Carotid Angioplasty and Stenting

Abstract

Carotid stenosis causes disturbing symptomatology in many patients and is known to increase the risk of stroke. Indeed, the cumulative 5-year risk of stroke in those with severe carotid stenosis and transient ischemic attacks (TIAs) is 30% to 35%.^1,2 The gold standard of therapy for carotid artery stenosis is carotid endarterectomy, a surgical technique that has been perfected over more than 40 years.³ The success of percutaneous endovascular intervention in a variety of anatomic regions has led to the introduction of carotid angioplasty and stenting as a means of treating carotid stenosis. Although those of us evaluating the technology would welcome the opportunity to study carotid endovascular interventions in a large clinical trial, sufficient funding has not yet been made available. In the absence of results from a major trial, there is heated debate about the appropriateness of carotid angioplasty and stenting. It has become clear that some carotid lesions are considerably more amenable to endovascular treatment than others. However, we do not yet have a definitive answer about the equivalency of these less invasive procedures with carotid endarterectomy. The current indications for carotid artery angioplasty and stenting are reviewed in this chapter, as are the techniques and clinical results.