Carotid artery stenting progress to date and the next steps

Abstract

Carotid artery stenting(CAS)is an alternative to carotid endarterectomy(CEA)that promises long- term efficacy. Patients indicated for carotid revascularization often have systemic atherosclerotic disease, therefore CAS has advantage in its ability to reduce periprocedural systemic complications including myocardial infarction via its less invasiveness. However, recent large randomized control trials have revealed that CAS has a higher potential risk of periprocedural ischemic stroke. The main factors likely to participate this event are incomplete embolic protection during balloon or stent angioplasty, and post-procedural thrombus that emerges on the stented area associate to the protrusion material through the bare metal stent. In this article, we present an outline of the recent randomized control trials, SPACE, EVA-3S, ICSS, CREST and ACT-1, and focus on the cerebral ischemic complications in these trials, and describe in detail of the mechanism of periprocedural thromboembolic events and their countermeasures. Reducing of periprocedural ischemic complication is the task to date, and active utilization of proximal balloon embolic protection to unstable plaque on tailor-made manner and newly developed micro mesh- covered stent may affect the efficacy of CAS as we go forward.