Current status of carotid artery angioplasty and stent placement: Impact of recent clinical studies

Carotid angioplasty with stent placement has emerged as an alternative treatment for carotid artery stenosis. Because it is a less invasive procedure and does not require general anesthesia, this intervention is a good choice for patients at high surgical risk. Additional advantages include easier access to anatomically challenging lesions and shorter length of hospital stay with reduced costs. Its major disadvantage is the possibility of debris dislodgement in the aortic arch and supra-aortic vessels during device manipulation, which can lead to cerebral embolism. This concern led to the development of distal protection devices. Several randomized trials have been published without actual proof of superiority of endovascular intervention over the standard treatment except for high-risk patients. In recent years, technical developments, cumulative experience, and new standards for training have reduced the complication rates. Ongoing trials will provide the evidence to demonstrate whether this intervention is superior to carotid endarterectomy, and if so, in which subgroup of patients.