Intermediate outcome after carotid stenting: what should we expect?

Atherosclerosis of the extracranial carotid artery is a major public health burden. Stroke is the third leading cause of death in Western countries, after heart disease and cancer, and the leading cause of long-term disability. In the United States, there are more than 500,000 strokes annually, accounting for approximately 3 million stroke survivors with varying degrees of disability. Data from stroke registries suggest that internal carotid artery atheroembolic disease accounts for approximately 35% of all ischemic cerebral infarctions; therefore, approximately 150,000 strokes in the United States per year may be ascribed to carotid disease. Surgical endarterectomy has been shown to be superior to medical management in the management of severe carotid stenosis in both symptomatic and asymptomatic patients. Indeed, carotid endarterectomy has been one of the most heavily scrutinized operations over the past 40 years, and newer methods of revascularization are being actively explored. With the great technological advances in the endovascular treatment of both peripheral and coronary atherosclerotic disease, many of these techniques are now being applied to the extracranial circulation. We explore the rapidly expanding field of carotid artery angioplasty and stenting. The upcoming prospective randomized clinical trials of surgical endarterectomy versus carotid angioplasty and stenting also are reviewed.