Despite a number of randomized trials, debate continues about the role of carotid angioplasty and stenting (CAS) for both symptomatic and asymptomatic disease. None of the trials has shown superiority of one treatment modality over the other, but protagonists of stenting have encouraged a shift away from conventional surgery. The minimally invasive nature of CAS is appealing, but concerns have been raised about the periprocedural stroke rate in the randomized trials. To counter this evidence, there are increasing numbers of registries and series, many partly or wholly sponsored by the endovascular industry, some of which demonstrate reasonable results. These need to be studied with caution, as patients deemed high risk of carotid endarterectomy may actually be at very low risk of stroke. Furthermore, strict inclusion and exclusion criteria mean that results may not be a true reflection of everyday clinical practice.
The aim of this review is to document the evidence to date, predominantly from the randomized trials, for both symptomatic and asymptomatic carotid disease and establish the current role of carotid stenting.
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