Abstract and Introduction
Abstract
In patients with carotid disease, the purpose of carotid artery revascularization is stroke prevention. For >50 years, carotid endarterectomy has been considered the standard treatment for severe asymptomatic and symptomatic carotid stenoses. Carotid artery stenting (CAS) has emerged in the last 15 years as minimally invasive alternative to surgery. However, the value of the endovascular approach in the management of carotid disease patients remains highly controversial. The aims of this review are to elucidate the current role of CAS, to describe the major technology advancements in the field, and to speculate about the future of this therapy.
Introduction
Ten to 15% of all ischaemic strokes originate from a stenosis at the level of the internal carotid artery. In patients with carotid disease, the purpose of carotid revascularization is the prevention of (recurrent) stroke. For >50 years carotid endarterectomy (CEA) has been considered the standard treatment for severe asymptomatic and symptomatic carotid stenoses. Carotid artery stenting (CAS) has emerged in the last 15 years as minimally invasive alternative to surgery. However, its role remains highly controversial. The debate has been fuelled by the multiples medical specialties involved as well as by the disappointing results of CAS in randomized comparisons with CEA. While some have interpreted those findings as clear-cut clinical evidence, other have suggested that most of the trials may have compared the two revascularization modalities in an unfair way. Aims of this review are to elucidate the current role of CAS in the management of patients with advanced carotid disease, to describe the major technology advancements in the field, and to speculate about the future of this therapy.