Carotid artery stenting: clinical trials and registry data

Despite the lack of Level I evidence, carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA). Furthermore, CAS has been met with considerable enthusiasm due to its minimally invasive nature and potential application to high-risk patient populations. Several investigations including multicenter registries and randomized controlled trials have been established and are currently underway in an effort to evaluate the noninferiority and efficacy of CAS as compared to CEA. To date, no trial has definitively shown equivalence of CAS to CEA for the treatment of carotid stenosis and consensus recommendations for use of CAS remain very restricted. Nevertheless, the existing data have provided useful information with respect to differential outcomes in subgroups, including symptom status, age, gender, and high-risk patient populations. Until the noninferiority of CAS is clearly demonstrated in a randomized controlled setting, CEA remains the gold standard for treatment of carotid stenosis and use of CAS must be carefully considered on an individual patient basis.