How to introduce carotid angioplasty without compromising patient safety

Carotid angioplasty with stenting (CAS) is increasingly being used in the treatment of extracranial carotid disease and numerous studies have demonstrated its feasibility. However, the exact role of CAS in the treatment of carotid stenosis and its long-term efficacy has not been defined. The assessment of the patient's medical condition, the exact identification of vessel anatomy as well as anomalies of the aortic arch and the cervicocerebral circulation is required for successful and safe performance of CAS. New CAS practitioners would be advised to start their experience in patients with predominantly easier anatomical situation as well as plaque configuration. The appropriate selection of interventional techniques as well as vascular access for CAS is dependent on the anatomy of the aortic arch and of the CCA proximal to the target lesion. Usually a retrograde femoral artery approach to access the CCA is preferred. In order to treat a patient safely with carotid artery stenting, it essential for interventionalists to appropriately chose a patient suited for endovascular therapy, to identify possible sources of complications prior to the interventional procedure as well as to know the key points for a successful carotid artery intervention. An interdisciplinary evidence-based approach will facilitate the choice of optimal intervention for each patient. Finally, trainee programs for physicians starting with CAS as well as facility certification are absolutely mandatory to ensure high success rates as well as low complication rates.