Carotid stenting trials: what have they taught us?

Carotid artery occlusion is one of the most frequently identified and one of the most treatable causes of ischemic strokes. Although carotid endarterectomy (CEA) is recognized as the gold standard for treating symptomatic, severe carotid stenosis, the development of carotid angioplasty and stenting (CAS) has encouraged investigations to demonstrate its safety and efficacy as a viable alternative to surgical management. Recent findings have emphasized patient selection as the key to the judicious application of CAS as well as CEA. More than proving CAS as a noninferior alternative to a surgical gold standard, trials exploring the relationship of various factors to patient outcomes may show that endovascular procedures will complement and improve on surgical techniques for treating a wide spectrum of patients suffering from carotid disease.