Carotid Artery Stenting for the Prevention of Thromboembolic Stroke

Stroke is the third most common cause of death in Western civilizations, and the single most common cause for permanent disability. Approximately 20% to 30% of ischemic strokes are caused by high grade carotid artery stenosis, and revascularization therapy has the potential to resolve this problem. Traditionally, carotid endarterectomy (CEA) is considered the Gold standard for treatment of symptomatic and asymptomatic high-grade internal carotid artery (ICA) obstructions with a degree of stenosis above 70%. Recently, carotid artery stenting (CAS) emerged as an accepted alternative method for treatment of patients with high-grade carotid artery stenosis, who are at an increased risk for surgical carotid endarterectomy (CEA). The reported rates of neurological complications of CAS substantially decreased during the past years, and the routine use of cerebral protection devices and low profile catheter systems have further increased the procedure's safety. Provided that the ongoing randomized controlled trials comparing CAS and CEA confirm equivalence between these methods, CAS like CEA may be applicable to a more general population of patients with high grade carotid artery stenosis in the near future. The present article critically reviews the evidence that endovascular treatment of high grade carotid artery stenosis by elective CAS may be beneficial in the prevention of thromboembolic stroke.