Carotid Artery Angioplasty and Stenting

Extracranial atherosclerotic disease is thought to cause approximately 16% of ischemic strokes. Because approximately 795,000 new or recurrent strokes occur annually in the United States, carotid artery disease is a major cause of disability and mortality. Through large clinical trials (North American Symptomatic Carotid Endarterectomy Trial, Asymptomatic Carotid Atherosclerosis Study, Asymptomatic Carotid Surgery Trial, European Carotid Surgery Trial), treatment of this pathologic condition has been shown to decrease the rate of stroke compared with medical management alone. Advances in endovascular technology and increasing experience with carotid artery angioplasty and stenting (CAS) have made this technique comparable, and in many cases preferable, to carotid endarterectomy for the treatment of carotid stenosis. This chapter reviews the historical development of endovascular strategies for the treatment of extracranial carotid artery disease, the current evidence supporting CAS, current indications for CAS, technical nuances of the procedure, and perioperative and complication management.