ABSTRACT
Carotid revascularization has evolved as an important tool to prevent thromboembolic strokes and deaths over the past five decades. In the United States, stroke is the leading cause of disability and the third leading cause of death (1). The recognition that the majority of strokes have an ischemic basis from embolism (24%) or thrombosis (61%) fueled the development of effective preventive strategies (1). Medical therapies with antiplatelet, antihypertensive and lipid-lowering agents play vital roles in reducing ischemic strokes. Atherosclerotic preventive strategies including smoking cessation and optimal diabetic treatment are also effective. In addition, surgical revascularization with carotid endarterectomy (CEA) has long been established as the gold standard procedure for preventing strokes with benefit in patients with >50% symptomatic, or >60% asymptomatic carotid stenosis (2-4). This modality, however, may soon be supplanted by percutaneous carotid artery stenting (CAS), at least in high surgical risk patients. CAS was recently proven to be superior to CEA in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial in patients at high-risk for CEA (5). Further randomized data involving low-risk patients currently in progress are expected to propel the upsurge in CAS. It is important to appreciate that CAS is a technically challenging procedure, requiring meticulous technique to reduce procedural complications. Before embarking on this procedure, operators should have a thorough understanding of the prevention and management of complications.
