Primary carotid stenting.

A 66-year-old male presented with right hemispheric transient ischemic attacks. Computed tomography angiography (CTA) demonstrated a very severe atherosclerotic stenosis of the proximal right internal carotid artery, > 95% by NASCET criteria. Carotid stenting was performed using a self-expanding stent (SES) alone, without balloon angioplasty or embolic protection. An immediate anteroposterior (AP) x-ray of the neck (Figure 1) shows the stent in place. A carotid Doppler done the same day demonstrated a peak systolic velocity (PSV) of 142 cm/sec and an internal carotid to common carotid artery (ICA/CCA) velocity ratio of 1.8, corresponding to a stenosis of approximately 50%. Six weeks later, the stent had gently expanded by itself (Figure 2). The Doppler showed a PSV of 91 cm/sec and an ICA/CCA ratio of 0.87, indicating no residual stenosis. The patient remains asymptomatic. In the major randomized controlled trials (RCTs) comparing carotid endarterectomy to carotid angioplasty and stenting (CAS), the endovascular procedure is performed using pre-and