Carotid angioplasty and stenting.

The endovascular management of carotid artery disease is a rapidly developing area currently under evaluation in Europe and the US. The technique is a simple progression of those skills used in peripheral vessels and involves the percutaneous placement of a metallic stent. Current data indicate that it may well offer a similar safety profile and efficacy at stroke prevention as conventional endarterectomy, but as yet there has only been one randomised controlled trial (CAVATAS). Future developments include the identification of a cohort of patients best treated with this technology, the evaluation of cerebral protection systems, and optimisation of pharmacological support.