Carotid Artery Stenting Versus Carotid Endarterectomy: Current Status

Approximately 700,000 new and recurrent strokes occur in the United States each year [1]. Atherosclerotic narrowing of the extracranial internal carotid artery (ICA) is estimated to be causative in more than 10 % of cases [2]. The results of large, prospective, randomized controlled trials (RCTs) demonstrate the superiority of carotid endarterectomy (CEA) plus medical therapy over medical management alone for prevention of ipsilateral stroke in patients who are symptomatic and those who are asymptomatic [3–7]. The advent of minimally invasive endovascular approaches to treatment of extracranial carotid occlusive disease has generated interest in these tech-niques as alternatives to surgical revascularization. The potential of balloon angioplasty and stenting of the carotid artery to reduce patient discomfort and postprocedural complications has made this therapeutic alternative attractive to patients and physicians. Randomized trials of carotid angio-plasty and stenting (CAS) are underway in North America and Europe. This article highlights the pivotal data demonstrating the effectiveness of CEA and focuses on evidence from completed and ongoing trials of CAS as a treatment alternative for carotid atherosclerosis. Related issues, includ-ing safety, durability, and cost-effectiveness, also are discussed. Clinical trials of carotid endarterectom