Carotid Angioplasty and Stenting and Embolic Protection

We review the evidence on the safety and efficacy of carotid angioplasty and stenting (CAS) compared to carotid endarterectomy (CEA) and also summarizes emerging technical issues.

Randomized trials have demonstrated a progressive decrease of periprocedural strokes after CAS. Overall, in symptomatic patients, CAS is associated with a slightly higher risk of periprocedural strokes when compared to CEA. This is especially true after the age of 70 and immediately after a presenting symptomatic event. CAS is associated with lower incidence of periprocedural cardiac events and cranial nerve palsies. Both procedures are equally effective in preventing future ipsilateral ischemic events, and restenosis after CAS is not a major limitation. In asymptomatic patients, CAS is as safe as CEA, although modern medical therapy may be as effective as any carotid intervention. CAS is a valid alternative to CEA in selected patients with symptomatic carotid stenosis. In asymptomatic patients, the two procedures are equally safe, although medical therapy alone may be as effective.