Carotid angioplasty and stenting: how to avoid complications

Carotid angioplasty and stenting (CAS) has been proposed as an alternative to surgery and is now more and more performed and well accepted, at least for high surgical risk patients. However complications and particularly embolic strokes, even with a meticulous technique, can occur at any step of the procedure. Silent embolism is detected after CAS and may be a problem that needs to be discussed. To avoid and reduce these complications associated with CAS we must have: good indications depending on good patients and lesions selection. New parameters have been proposed particularly for asymptomatic lesions, correct technique, embolic protection devices (EPD) are mandatory for any CAS. New techniques will be presented. The choice of the EPD depends on the clinical status of the patient, the lesion morphology and characteristics, the anatomy of the artery, good choice of the stent and correct implantation (all stents are not equivalent), pharmacological adjuncts, experienced operators, good team. With all these considerations CAS can now be performed with acceptable outcomes and in certain population the results are comparable or superior to surgery. The results of ongoing randomized trials are awaited.