[Carotid angioplastic: what future?]

ADVANTAGES AND RISKS: Widely advocated as reliable and cost-effective, carotid angioplasty offers many advantages. Theoretically, general anesthesia can be avoided and no incision is required, authorizing its indication in patients with a contraindication for conventional open surgery although the risks of vascular complications--emboli, dissection, acute thrombosis--and general complications must not be underestimated. NEED FOR VALID ASSESSMENT: Few studies evaluating this new technique have been published. Among the open trials including over 100 patients, indications have generally been limited to patients with a high surgical risk and combined morbidity and mortality has been reported to vary from 2.8% to 9.6%. No rigorously controlled comparison with conventional surgery has been published although several projects are currently under way or in the planning stages (CAST in Europe and CASET and CREST in North America). LESSONS FROM THE CURRENT SITUATION: Carotid angioplasty requires a highly equipped facility and a multidisciplinary team with competence in catheterization and micro-catheterization, thrombolysis, and stenting techniques. Technical advances in material engineering are also needed to provide flexible, stable and modulable stents. Despite the still imprecise nature of the current situation, one can predict that these techniques will come to be complementary, if not competitive, alternatives to conventional carotid surgery.