Angioplasty and stenting for carotid artery stenosis: Indications, technique, results, and complications

The favorable results obtained with angioplasty and stenting in the treatment of coronary artery disease have led to consideration of this technology for the treatment of carotid artery stenosis. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk candidates for surgery. Early series have suggested that endoluminal revascularization in these patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates after angioplasty and stenting compares favorably with that associated with surgery, more recent clinical series have suggested that the incidence of perioperative transient neurologic events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurologic symptoms and 'unstable' plaques. The authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. Potential applications of stenting to intracranial thromboocclusive carotid disease are also reviewed.