ABSTRACT
In Western countries, stroke is the third most common cause of death behind cardiac disease and cancer, and is the number one condition associated with serious, long-term disability. Large-scale randomized clinical trials have established the superiority of carotid endarterectomy (CEA) over medical management in patients with high-grade carotid stenosis. A stenosis of the vertebral artery (VA) rarely causes symptoms, and revascularization is seldom required. While surgery is not considered a viable option for VA stenosis in most centers, the number of endovascular vertebral procedures remains limited compared with carotid artery stenting (CAS) procedures. Prior to CAS, noninvasive assessment of extracranial and intracranial circulation by either computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is recommended. As for carotid angiography, the procedure is usually performed in local anesthesia and using a femoral approach. The presence of a carotid bruit is neither sensitive nor specific for the presence of a significant stenosis of the internal carotid artery (ICA).
