Carotid artery stenting: a 2009 update

Abstract

Carotid endarterectomy (CEA) is still considered the gold standard in the treatment of patients with significant carotid stenosis and has proven its value over the past decades. Endovascular techniques have evolved, and carotid artery stenting (CAS) is challenging CEA to become the better treatment. Various trends were noted throughout the past decade with shifts against and pro CAS. The aim of this review is to describe the most important findings related to CAS, published in the last 1.5 years, in order to present its current status. A total of 12 randomized trials have been initiated at this moment. The long-term results of both the Stent-Protected Angioplasty versus Carotid Endarterectomy and Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trials were published last year. Last month, primary safety data from the International Carotid Stenting Study trial were also presented. All these three trials failed to show superiority of CAS. Results favored CEA mainly because of periprocedural complications with CAS. It is anticipated that whenever eligible for CEA, patients should be scheduled to undergo surgery, reserving CAS for high-risk patients and patients with anatomical restrictions. Most likely, evolving best medical treatment, timely intervention and analysis of plaque composition will have an important influence on the future treatment of carotid artery stenosis, regardless of the treatment option chosen.