Abstract
Large numbers of patients are currently being treated with endovascular alternatives to open surgical procedures. Over the last decade, neurosurgery has been exposed to this surgical evolution, particularly in the area of coil embolization of cerebral aneurysms. Several lessons have been learned; possibly the most important one is that high-quality scientific study of this new technology is extremely difficult and has not been able to keep pace with the explosion in device advancements. The next wave of influence in our field is currently being experienced in the treatment of carotid artery (CA) stenosis. Carotid endarterectomy has long been considered the standard of care for a very well-defined patient population with CA stenosis. Despite limited findings in the literature to support such a shift, many patients undergo stent-assisted carotid angioplasty as a true alternative to endarterectomy rather than being selected for endovascular treatment based on objective criteria. The influence of medical device companies has been considerable in this area, and to date, most peer-reviewed data have been generated by company-sponsored trials.
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