[State of the art in carotid artery stenting 2012]

Stenosis of the internal carotid arteries is one of the leading causes of ischemic stroke. With increasing age of the general population, both physicians and patients have to increasingly face that problem, which is often found accidentally for example in the context of a routine checkup examination. In patients over seventy years, the incidence of carotid artery stenosis is about 15%. Principally, there are three options for the treatment of carotid artery stenosis: 1) best medical treatment, 2) operative revision by endarterectomy and 3) interventional therapy via stent implantation. Based on technical development and new scientific data, there has been tremendous progress of all three treatment strategies in the last few years. Therefore, the results of prior trials must not necessarily be considered when choosing a treatment option for the patient. The choice of therapy for the individual patient must take into account a number of criteria, such as grade of stenosis, symptoms, patient age, concomitant disease, anatomical conditions and patients' preference. Recently, a number of clinical trials have been performed to compare operative versus interventional treatment. The results of these studies led to some answers, but there are questions remaining which need to be clarified. The present article gives a brief overview and comment on the current status of treatment strategies of internal carotid artery stenosis based on the recent literature.