Carotid Stenting

Carotid Stenting – Carotid artery stenting (CAS) is an endovascular, catheter-based procedure which unblocks narrowings of the carotid artery lumen to prevent a stroke. Carotid artery stenosis can present with no symptoms (diagnosed incidentally) or with symptoms such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). The largest clinical trial to date, CREST, compared stenting to surgery on the collective incidence of any stroke, any heart attack or death. They found that there were no significant differences out to four years of follow-up between surgery and carotid stenting when counting all three, but carotid endarterectomy (CEA) has a higher risk of heart attacks and CAS has a higher risk of minor stroke than open surgery. Overall, younger patients (<70 years old) had better outcomes with stenting than with surgery. Patients had fewer heart attacks with stenting, but they did have more minor strokes. There was no difference between surgery or stenting for major (disabling) strokes.