Carotid stenting: which stent for which lesion?

Dedicated catheter and stent systems for use in the carotid circulation have only been developed recently. Almost exclusively, self-expandable metallic stents are being used. Longitudinal flexibility, contourability of the luminal configuration, sufficient radial resistive force, narrow meshwork for sealing of the diseased vessel wall, low profile of the constraint stent, and compatibility of the devices with routine angioplasty techniques are the premier requirements. Most of the current experience is based on the longitudinal wire mesh design (Carotid Wallstent). The narrow meshwork has excellent sealing capacity but the inherent (yet manageable) problem of foreshortening with expansion needs attention. The segmented ring designs of the more recent Nitinol stents permit more precise positioning and contouring of the luminal surface, yet their capacity to seal a complex or thrombotic lesion and their clinical safety needs further evaluation. As more distinct features of dedicated carotid stents are being developed and as their differential importance gets recognized, a more meaningful and individual stent selection for the carotid anatomy may further improve clinical outcome.