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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2007 March;14(1):9-16
Carotid artery stentinG. A review
Cao P. G., De Rango P., Cieri E.
Division of Vascular and Endovascular Surgery S. Maria della Misericordia Hospital University of Perugia, Perugia, Italy
Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) for the treatment of carotid stenosis, yet there remains a substantial amount of variability and uncertainty in clinical practice in the referral of patients for stenting versus endarterectomy. By undertaking a review of the literature, messages were taken in order to better define benefit from carotid stenting versus endarterectomy. CAS may be favorably compared to CEA only in experienced hands and fully trained centers: the learning curve is longer than previously expected for this procedure. Not all symptomatic patients may undergo CAS with the same periprocedural risk: older patients and recently symptomatic patients may still benefit from CEA. Larger sample size is needed to clarify the risk-benefit ratio of CAS versus CEA especially in asymptomatic patients. Ongoing, correctly designed, large randomized trials will help determine optimal carotid revascularization strategies in the future.