Carotid stenting intervention, patient

Due to the very low event rates in patients with asymptomatic lesions of moderate severity (<60% diameter stenosis), it is unknown whether currently available interventional techniques can improve long-term outcomes over those achievable with optimal medical management. Also unresolved are the indications for carotid stenting in asymptomatic individuals with contralateral carotid occlusion (53) and those undergoing major cardiac or vascular surgery (54). 

This concern extends to carotid artery stenting. Although carotid artery stenting in patients with asymptomatic CAS can be performed by experienced operators with a low complication rate, the procedure can be associated with high complication rate if performed by inexperienced operators, particularly in older patients with complex anatomy (24). In any case, institution-specific assessment of the risk of carotid intervention, endarterectomy, or stenting should be a prime consideration in clinical decision making regarding carotid revascularization in patients with asymptomatic CAS. 

Although only a minority of patients with TIA or ischemic stroke are potential candidates for carotid endarterectomy (CEA) or stenting, the decision to opt for interventional treatment rather than medical treatment alone can be difficult and is, therefore, given detailed consideration in this Ch. Most of the discussion relates to CEA because far more data are available on the risks and benefits of surgery than for stenting. However, most of the issues discussed are applicable to both procedures. 

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