ABSTRACT
This chapter reviews the existing safety and efficacy data on carotid artery stenting (CAS). During the late 1980s and early 1990s, a series of multicenter randomized controlled clinical trials (RCTs) conducted in Europe and North America demonstrated the superiority of carotid endarterectomy (CEA) plus medical management vs. medical management alone for the prevention of stroke among patients with atherosclerotic carotid bifurcation stenosis. The majority of the published data on CAS consists of noncontrolled single-center case series, most without independent verification of outcome events. The rationale for the use of cerebral protection devices for CAS is compelling. Surgeons experienced with CEA have long recognized the potential to dislodge the friable material present in carotid bifurcation plaques. The data on CAS consists of a limited number of flawed RCTs in addition to a large number of case series and registries with inherent biases.
