Cerebral Protection for Carotid Artery Stenting: Safety, Efficacy and Limitations

Although carotid endarterectomy (CEA) has been proven more effective than medical management in the prevention of stroke in patients with symptomatic or asymptomatic carotid artery stenosis, it has its disadvantages, including a neck incision and the requirement for general anesthesia in some patients. Additionally, surgical intervention also has limitations for those patients with severe bilateral carotid artery stensosis, the stenosis caused by neck irradiation for nasopharyngeal cancer, high level of carotid artery stensosis, or restenosis following CEA. Carotid artery stenting, which is a less invasive percutaneous procedure, has been widely accepted as an alternative for patients with severe carotid artery stensosis. Furthermore, a number of randomized clinical trails have demonstrated that carotid stenting with emboli-protection device for treatment of patients with symptomatic and asymptomatic stenosis is not inferior to CEA in terms of short-term and long-term outcomes. Therefore, it is foreseeable that percutaneous transluminal stenting with emboli-protection device for patients with high-grade carotid artery stensosis will gain increasing popularity in the near future. Accordingly, it is of utmost importance to understand the benefits, safety, and the limitations of carotid stenting.