Carotid artery stent placement for atherosclerotic disease: Rationale, technique, and current status

Carotid arterial endarterectomy is considered to be the standard for the tr eatment of atherosclerotic carotid arterial occlusive disease. This has bee n validated with results of several randomized controlled trials in which i ts effectiveness has been demonstrated over that of the best nonsurgical th erapy. In the past several years, however, carotid angioplasty with stent p lacement has emerged as a potential alternative to carotid endarterectomy. This article represents a critical examination of the rationale for carotid revascularization; the history of endovascular techniques for the treatmen t of carotid atherosclerosis, beginning with balloon angioplasty and evolvi ng to the use of stents; and the evidence supporting the effectiveness of t he endovascular approach, A brief description of the current technical aspe cts of carotid artery stent placement is presented. The future status of th e endovascular approach will be determined with randomized trials in which carotid artery stent placement is directly compared with endarterectomy, as well as by the potential for further innovation and improvement in endovas cular devices, technique, and safety.