Summary And Conclusions

Since the advent of carotid angioplasty and stenting, practitioners have become more proficient, and the tools available to them have become smaller and more sophisticated. The procedures are used routinely for patients who are poor candidates for CEA and in cases of restenosis. Complications include surgical comorbidities common among older patients, those associated with insertion of catheters and the use of contrast, stroke (the risk of which is slightly increased over other cerebral angiographic procedures due to the presence of atherosclerotic disease), and bradycardia and assytoli resulting from the stretching of the baroreceptors in the carotid bifurcation. The use of carotid stenting is likely to increase, as it has recently been approved for coverage under Medicare to treat carotid stenosis >80% in patients with high-surgical risk. Given that the most recent improvements in all types of treatment—CEA, stenting, and nonsurgical—have not yet been fully evaluated and compared, it remains important for the field to continue to try to understand the natural history of atherosclerotic disease and to better understand what and when a plaque becomes unstable. For individual practitioners, the decisions of if, when, and how to intervene must be weighed carefully in each case.

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