Carotid artery stenosis: who should undergo surgery and who should undergo stenting?

Carotid angioplasty and stent implantation is a rapidly evolving treatment option currently under evaluation in several randomized trials. Although this technique needs some special technical skills and knowledge, it is technically simpler than many other interventional procedures. Current data indicate that the results regarding success rate and complication rate may be similar to surgery. It will take years to get the results of the randomized trials that are currently planed or have already started. Unfortunately, the results of these studies will not reflect the state-of-the-art because new stents and new protection devices will become available during these studies. Therefore, in clinical practice the decision has to be made depending on individual patient and lesion characteristics. Patients with concomitant diseases considered to be a risk factor for surgical procedures and patients with contralateral occlusion may be better candidates for angioplasty and stenting. However, patients with diffuse disease of the common carotid artery and patients with difficult vascular access may be better candidates for surgery.