Angioplasty and stenting to treat occlusive vascular disease

The advent of effective percutaneous treatment of occlusive vascular lesions by angioplasty and stenting is one of the most important contributions to medical care early in the 21st century. Evaluation of angioplasty and stenting procedures is still in a very early phase. New types of stents and other technologies and devices are being continuously developed and there is a definite learning curve. The experience, training, and number of procedures clearly relate to outcomes, and many different specialists are still learning and so far have not had optimal experience. This review provides an overview of studies that have examined the efficacy of stenting in conjunction with balloon angioplasty for carotid atherosclerosis compared with endarterectomy. Also discussed are angioplasty/stenting of other neck arteries and intracranial arteries and the key issues surrounding percutaneous intervention, including patient selection criteria, clinical assessment of lesions most suitable for treatment, the use of distal protective devices and drug-eluting stents, and recommendations for physician selection.