Complications associated with extracranial carotid artery interventions

Efforts to ameliorate the tremendous personal and financial ramifications of stroke in this country have focused on the recently validated stroke reduction potential of carotid endarterectomy. During the years in which numerous randomized trials compiled their evidence in favor of surgical treatment, the evolution of minimally invasive therapeutic alternatives to surgery spread to encompass nearly every vascular bed in the body. Only the fragile cerebrovascular system remains as the final challenge for interventionists. Any revascularization alternative to carotid endarterectomy should achieve the same initial and long-term outcomes as the surgical gold standard, with comparable morbidity and mortality. After years of cautious, circumspect application, carotid angioplasty is now a contender for this role. Assisted by the newer stent technology, minimally invasive carotid interventions are entering clinical trials. While it is premature to discuss the stroke reduction potential of these catheter-based techniques, it is imperative that we recognize and prepare to treat the myriad, sometimes catastrophic, complications of these therapeutic approaches to carotid obliterative disease.