ABSTRACT
This chapter discusses training, hospital privileges, protocols, proctoring, quality assurance, and interdisciplinary issues. The choice between carotid endarterectomy and carotid stenting is different from other open versus endovascular procedure debates. Carotid endarterectomy is an index vascular procedure, is the most commonly performed major vascular operation, and defines the field of vascular surgery. Until the late 1980s, carotid arteriography was required for each carotid endarterectomy case to determine the degree of stenosis and to evaluate the surrounding anatomy. The protocol for carotid stent placement should describe the overall plan. Patients who are good stent candidates due to high medical comorbidities may not always have favorable anatomy for stent placement and they also have an elevated risk of periprocedural complications, even from a percutaneous procedure. The best early candidates for carotid artery stenting are patients with focal recurrent stenosis.
