ABSTRACT
Carotid artery stenting (CAS) is an alternative treatment to carotid endarterectomy (CEA) and started with the development of self-expanding stents and then embolic protective devices. There have been several prospective randomized clinical trials reported comparing the results of CAS to CEA. Risk management is very important to reduce complications of carotid revascularization. Specifically for CAS, thromboembolic risk, anatomical risk, cardiac risk, plaque risk, and cerebral blood flow (CBF) risk should be evaluated before treatment. Clopidogrel is a pro-drug that must undergo hepatic biotransformation to convert the active metabolite that inhibits platelet aggregation. Therefore, the antiplatelet effect of clopidogrel is affected by CYP2C19 phenotypes. Cardiac function should be assessed before the treatment to rule out cardiac failure, ischemic coronary diseases, and valvular diseases. Balloon dilatation of the carotid artery frequently induces bradycardia and hypotension, which will aggravate the pre-existing cardiac failure and coronary ischemia.
