CAS: which stent for which lesion

Current carotid stent designs and their attributes like scaffolding to reduce plaque prolapses and embolization, flexibility, adaptability and conformability to the vessel vary largely. Knowing that differences in behaviour due to stent design exist, especially due to the open cell design (which show high flexibility and therefore adaptability to the vessel but allows in theory easy particle penetration due to open structure) and closed cell designs (which show low flexibility and therefore low adaptability to the vessel but show high resistance to particle penetration due to closed cell design and high scaffolding), physicians have to be aware of these differences when planning carotid artery stenting procedures. The individual characteristics of each stent device may make it an attractive choice in one circumstance but render it less desirable in other situations; in approximately 75% of all procedures, all types of stents will achieve similar outcomes, making adequate device selection unnecessary; for the remaining quarter, careful preoperative screening is mandatory. The aim of this article was to review different stents with regard to latest designs intended for carotid stenting with regard to topics as mentioned above highlighting latest developments in specific designs especially developed for carotid lesion treatment.