Abstract
As endovascular technology has evolved, a number of randomized controlled trials (RCTs) comparing outcomes after transfemoral carotid artery stenting (TF-CAS) versus the “gold standard” of carotid endarterectomy (CEA) to treat carotid artery stenosis were designed. Herein, we provide an overview of the major RCTs investigating TF-CAS. We also provide a summary of the current societal recommendations for TF-CAS versus CEA and summarize the major patient characteristics that must be considered when planning the procedure. We discuss major technical considerations for optimizing results, including use of an embolic protection device, access considerations, and perioperative medications. Finally, throughout the chapter, we review the evolving role of transcarotid artery revascularization (TCAR) as an alternative to TF-CAS.
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