Carotid artery stenting in recently symptomatic patients
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Updated: May 15, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
C Setacci1, G de Donato, F Setacci
1Unit of Vascular and Endovascular Surgery, Department of Surgery, University of Siena, Siena, Italy. setacci@unisi.it
Insights
For acute ischemic stroke patients with severe carotid artery stenosis, carotid artery stenting is a potential intervention. This review examines its indications and outcomes compared to traditional treatments.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Acute stroke treatment is time-sensitive, with early intervention improving outcomes.
- Effective interventions for acute ischemic stroke from high-grade internal carotid artery stenosis are limited.
- Cerebral revascularization risks include hemorrhagic infarction and hyperperfusion syndrome.
Purpose of the Study:
- To review the indications and outcomes of carotid artery stenting (CAS) in patients with recent symptomatic high-grade internal carotid artery stenosis.
- To compare CAS with carotid endarterectomy (CEA) in this patient population.
- To identify factors influencing the safety and efficacy of CAS.
Main Methods:
- Systematic review of existing literature on CAS for acute symptomatic internal carotid artery stenosis.
- Analysis of perioperative stroke and death rates associated with CAS.
- Comparison of CAS outcomes with historical data for CEA.
Main Results:
- Carotid endarterectomy (CEA) has strong evidence supporting its use in symptomatic patients.
- Carotid artery stenting (CAS) is a viable alternative in selected cases performed at high-volume centers.
- Key concerns for CAS include plaque remodelling and stabilization to prevent embolic events.
Conclusions:
- CAS may be considered for acute symptomatic internal carotid artery stenosis in specific patient groups.
- Careful patient selection and performance at experienced centers are crucial for successful CAS outcomes.
- Further research is needed to optimize CAS techniques and long-term results.
Abstract:
Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period. Although level 1 evidence seems clearly in favor of carotid endarterectomy in symptomatic patients, carotid stenting has been proposed as a possible alternative in selected cases if the procedure is performed in high-volume center with documented low perioperative stroke and death rates. This review summarizes indications and results for carotid artery stenting in recently symptomatic patients.
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