Abstract
Carotid endarterectomy has been established as the gold standard for the treatment of carotid stenosis. However, patients with high risk characteristics including advanced age, heart/lung diseases, diabetes mellitus, and vascular co-morbidities represent a large segment of the perioperative morbidity and mortality reported from endarterectomy trials. Carotid stenting has been presented as an alternative treatment especially for these high risk patients for several years. Recently, Wholey et al. repoted the outcome of carotid stenting collecting from a large number of hospitals. The initial success rate of stent implantation was 98.4%, and the complication rate within 30 days after the procedure were as follows ; transient ischemic attack : 2.82 %. minor stroke : 2.72%, major stroke : 1.49%, death: 0.86%. According to this report, carotid stenting seems feasible and safe. However, carotid stenting has two major problems to be solved, distal embolization and restenosis. Distal embolization of atherosclerotic debris as a consequence of stent implantation was the major reason of neurological complications, however recent investigations showed that distal protection devices can reduce the complication caused by distal embolization markedly. Restenosis, renarrowing of the lesion, was another problem, however the newest technology and knowledge developed in the field of cardiovascular interventions will solve this problem.
