Carotid Artery Stenting: A Vascular Surgeon-Endovascular Specialist's Perspective

Endovascular interventions were developed to provide minimally invasive alternatives to standard surgical therapies. Where an endoluminal technique has the potential to supplant its surgical predecessor, the rival must prove itself against the gold standard in terms of outcome, complications, and durability. In the case of carotid stenting, the stroke risk reduction data for carotid endarterectomy gathered from recent randomized trials appear to be unassailable. In the face of this challenge, why would we pursue an endoluminal alternative? Would the investment in resources and device development result in benefit to the patient? In this perspective, an endovascular surgeon proposes several possible case scenarios appropriate to carotid stenting and reviews progress to date on the investigation of this therapeutic alternative.