ABSTRACT
PART 1: INTRODUCTION AND ACTUAL EVIDENCE Several randomized trials comparing surgery with medical therapy have shown that prophylactic carotid endarterectomy (CEA) reduces the incidence of stroke in properly selected patients with high-grade symptomatic and asymptomatic carotid artery stenosis (1,2). Carotid angioplasty has a history of 30 years and can be considered an alternative treatment option after a period of technical development and growing clinical experience (3,4). Recent trials and numerous registries have shown a similar outcome of CEA and carotid artery stenting (CAS) concerning morbidity, mortality, and long-term results (5,6). Presently, it is not evident what for patients would have more benefit, whether from one or the other treatment modality. But the huge amount of CAS data, delivers some information about subgroups of patients who have an increased risk of endovascular therapy. Old age, anatomical variations, additional pathologic findings besides the carotid artery stenosis, may influence the choice of treatment. Some special cases will be presented and the technical peculiarities will be described.
