How to optimize carotid artery stenting

Carotid angioplasty and stenting is now an alternative to surgical endarterectomy to treat carotid occlusive disease and is becoming mainstream in medical practice. However, the information available, the procedure techniques and the technologies are still evolving and several issues are still being discussed. Mandatory training, familiarity with the indications and contraindications, knowledge of the technology and devices are paramount for the success, however, the devices for carotid stenting are still under development. The impact of stent design seems to be greater than previously appreciated. Carotid plaque morphology may be important for the indication of the procedure. The pre, trans, and postprocedure patient management of the patient is essential for reducing morbidity and mortality. Due to the devastating potential complications, compared with other endovascular and minimally invasive procedures, carotid stenting requires a much more strict scrutiny of the operators training and outcomes, since the improvement in the learning curve is accompanied by a comparative reduction in the complication rates. This article presents a review of the information available on how to optimize carotid stenting.