Carotid artery stenting: state of the art

In most developed countries, cerebrovascular accident (CVA) ranks second or third in mortality and is the leading cause of disability in adults. Ischemic stroke accounts for 70-90% of all cases of CVAs. Internal carotid artery (ICA) atherosclerosis with stenosis >50% account for 9-40% of ischemic strokes. Pharmacotherapy is the first-line treatment for patients with ICA atherosclerosis. However, some studies suggest that pharmacotherapy is ineffective in patients at high CVA risk. According to current Russian guidelines, carotid endarterectomy is the procedure of choice for patients with significant stenosis of the ICA. However, with the advances of endovascular technologies, carotid angioplasty with stenting has become an alternative revascularization option. According to the 10-year Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the predominant difference in cerebral ischemic events after carotid angioplasty with stenting versus carotid endarterectomy occurred in the periprocedural period. However, after successful surgery, the late-term complication rates in the stenting group and the open surgery group were comparable. Thus, proper preoperative preparation of patients for ICA stenting and periprocedural management are key to improving the outcomes of endovascular intervention.