Carotid artery angioplasty: where are we in 2004?

Carotid artery stenting (CAS) is currently being investigated as an alternative treatment to carotid endarterectomy (CEA). Cerebral embolism is the most serious risk of CAS. Carotid artery stenting is still not reimbursed and unauthorised not authorised in routine in France (excepted in trials with ethical committee approval). CAS is now feasible, with a high technical success, which may improves with learning curve and with a better patient selection of the patients. A number of higher risk situations for CEA represents ideal indications for CAS, such as restenosis after CEA, stenosis due to prior neck radiation and radical neck surgery, and lesions in the distal internal carotid artery or involving high, retromandibular bifurcation.