ABSTRACT
The growing use of carotid stenting as an alternative to carotid endarterectomy by interventionalists from a number of different specialty areas (cardiology, radiology, neurology, and vascular surgery) requires an understanding of the entire vascular tree from the aortic arch to the intracranial arteries. Selective angiography of the supraaortic vessels with intracranial views is imperative in order for a rational decision to proceed with carotid stenting (CS) can be made. Intracranial anomalies as well as incidental pathological findings are also important to diagnose. For example, intracranial stenoses, cerebral aneurysms, arteriovenous malformations, and neoplasms need to be identified and may preclude CS. The most common cerebrovascular disease affecting the supraaortic vessels is atherosclerosis; however, fibromuscular dysplasia and traumatic abnormalities may also require stenting. In addition, knowledge of the collateral routes in the cerebral circulation is important for stroke-risk stratification and selection of distal protection devices used during carotid stenting.
