[Angioplasty and stenting in carotid stenosis. Therapeutic alternative or technical possibility?]

Review the current knowledge on the use of angioplasty and stenting (A/S) for the treatment of carotid stenosis with emphasis on proposed indications.

The standard treatment for carotid stenosis is carotid endarterectomy (CE). However, excessive surgical risk and/or technical difficulty occasionally impose limitations on the surgical approach. Therefore, the option of percutaneous treatment with A/S becomes an appealing alternative. A/S techniques are constantly improved but there is very little prospective data supporting its value at present. The reported complication rates appear comparable to those of CE. Indications for A/S of the carotid artery are not fully delineated yet. We believe that adequate candidates for carotid A/S must have symptomatic high-degree carotid stenosis and at least one of the following situations: unstable coronary disease, severe systemic disease, surgically inaccessible carotid lesion (including some cases of carotid stenosis secondary to neck radiation), contralateral carotid occlusion, or recurrent stenosis after prior CE.

A/S represents a promising alternative to CE in the treatment of carotid stenosis. However, in the absence of prospective comparative trials, A/S should be currently reserved exclusively for those patients in whom surgery is prohibited by very high surgical risk or technical inaccessibility. A/S of the carotid artery should only be performed by operators with ample expertise in the field.