Thromboembolic complications from atherosclerotic disease of the carotid bifurcation are a common etiology of ischemic stroke, which has a significant morbidity and mortality. Carotid artery angioplasty and stenting (CAS) has been proposed as an alternative therapy for patients requiring treatment of carotid artery stenosis as opposed to the “gold standard” surgical intervention, carotid endarterectomy (CEA). Intense debate regarding these 2 therapeutic approaches has centered on their respective safety profiles. To date, despite multiple studies, no convincing evidence demonstrates the superiority or even equality of CAS to the proven safety, efficacy, and durability of CEA. This chapter reviews in detail the available evidence for CAS and CEA and provides a rationale that, given the available data, CEA remains the preferred therapy for the majority of patients who require treatment of carotid artery stenosis.
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