Semin intervent Radiol 2009; 26(4): 324-332
DOI: 10.1055/s-0029-1242200
© Thieme Medical Publishers

Carotid Artery Stenting: What You Need To Know

Rahul S. Patel1 , Barry T. Katzen2
  • 1Division of Vascular and Interventional Radiology, University of Maryland Medical Center, Baltimore, Maryland
  • 2Baptist Cardiac and Vascular Institute, Miami, Florida
Further Information

Publication History

Publication Date:
17 November 2009 (online)


Carotid stenting has become an accepted alternative in patients with carotid stenosis. The purpose of this article is to review the relevant trials, describe the different devices available for stenting, the devices for cerebral protection, as well as describe techniques and tricks for successful carotid artery stenting. Understanding how to appropriately preoperatively evaluate patients and intra- and postoperative procedures, carotid artery stenting can be a safe procedure.


  • 1 Lloyd-Jones D, Adams R, Carnethon M American Heart Association Statistics Committee and Stroke Statistics Subcommittee et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.  Circulation. 2009;  119 e21-e181
  • 2 North American Symptomatic Carotid Endarterectomy Trial Collaborators . Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.  N Engl J Med. 1991;  325 445-453
  • 3 Executive Committee for the Asymptomatic Carotid Atherosclerosis Study . Endarterectomy for asymptomatic carotid artery stenosis.  JAMA. 1995;  273 1421-1428
  • 4 Barnett H J, Taylor D W, Eliasziw M et al.. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1998;  339 1415-1425
  • 5 CAVATAS Investigators . Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.  Lancet. 2001;  357 1729-1737
  • 6 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).  Lancet. 1998;  351 1379-1387
  • 7 Naylor A R, Bolia A, Abbott R J et al.. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial.  J Vasc Surg. 1998;  28 326-334
  • 8 Yadav J S, Wholey M H, Kuntz R E Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients.  N Engl J Med. 2004;  351 1493-1501
  • 9 Gray W A, Hopkins L N, Yadav S ARCHeR Trial Collaborators et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results.  J Vasc Surg. 2006;  44 258-268
  • 10 Iyer S S, White C J, Hopkins L N BEACH Investigators et al. Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group.  J Am Coll Cardiol. 2008;  51 427-434
  • 11 Hopkins L N, Myla S, Grube E et al.. Carotid artery revascularization in high surgical risk patients with the NexStent and the Filterwire EX/EZ: 1-year results in the CABERNET trial.  Catheter Cardiovasc Interv. 2008;  71 950-960
  • 12 Safian R D, Bresnahan J F, Jaff M R CREATE Pivotal Trial Investigators et al. Protected carotid stenting in high-risk patients with severe carotid artery stenosis.  J Am Coll Cardiol. 2006;  47 2384-2389
  • 13 CARESS Steering Committee . Carotid revascularization using endarterectomy or stenting systems (CARESS): phase I clinical trial.  J Endovasc Ther. 2003;  10 1021-1030
  • 14 Ringleb P A, Allenberg J, Brückmann H SPACE Collaborative Group et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial.  Lancet. 2006;  368 1239-1247
  • 15 Mas J L, Chatellier G, Beyssen B EVA-3S Investigators et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.  N Engl J Med. 2006;  355 1660-1671
  • 16 Katzen B T, Criado F J, Ramee S R CASES-PMS Investigators et al. Carotid artery stenting with emboli protection surveillance study: thirty-day results of the CASES-PMS study.  Catheter Cardiovasc Interv. 2007;  70 316-323
  • 17 Lin S C, Trocciola S M, Rhee J et al.. Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting.  Ann Vasc Surg. 2005;  19 798-804
  • 18 Faggioli G L, Ferri M, Freyrie A et al.. Aortic arch anomalies are associated with increased risk of neurological events in carotid stent procedures.  Eur J Vasc Endovasc Surg. 2007;  33 436-441
  • 19 Chaturvedi S, Yadav J S. The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention.  Stroke. 2006;  37 1572-1577
  • 20 Aronow H D, Shishehbor M, Davis D A et al.. Leukocyte count predicts microembolic Doppler signals during carotid stenting: a link between inflammation and embolization.  Stroke. 2005;  36 1910-1914
  • 21 Payne D A, Jones C I, Hayes P D et al.. Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy.  Circulation. 2004;  109 1476-1481
  • 22 Wholey M D, Wu W, Toursarkissian B. An alternative technique for complex aortic arch access.  Endovasc Today. 2008;  7 61-66
  • 23 Feldtman R W, Buckley C J, Bohannon W T. How I do it: cervical access for carotid artery stenting.  Am J Surg. 2006;  192 779-781
  • 24 Hopkins L N, Clair D. EMPiRE: A multicenter registry evaluating neuropretection during carotid stenting with a novel flow reversal system. Paper presented at: Transcatheter Cardiovascular Therapeutics October 12–17, 2008 Washington, D.C.;
  • 25 Bosiers M, de Donato G, Deloose K et al.. Does free cell area influence the outcome in carotid artery stenting?.  Eur J Vasc Endovasc Surg. 2007;  33 135-141 discussion 142-143
  • 26 Schillinger M, Gschwendtner M, Reimers B et al.. Does carotid stent cell design matter?.  Stroke. 2008;  39 905-909
  • 27 Wholey M H, Al-Mubarek N, Wholey M H. Updated review of the global carotid artery stent registry.  Catheter Cardiovasc Interv. 2003;  60 259-266
  • 28 Younis G A, Gupta K, Mortazavi A et al.. Predictors of carotid stent restenosis.  Catheter Cardiovasc Interv. 2007;  69 673-682
  • 29 Armstrong P A, Bandyx D F. Duplex ultrasound surveillance after carotid stent angioplasty: when to follow-up and what to look for.  Vasc Disease Mgmt. 2007;  460-466
  • 30 Diehm N, Baum S, Katzen B T, Kovacs M, Benenati J. Fracture of a carotid stent: a word of caution.  J Vasc Interv Radiol. 2008;  19 622-623

Barry T KatzenM.D. 

Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive

Miami, FL 33176