New data about stenting versus endarterectomy for symptomatic carotid artery stenosis.

Patients with symptomatic carotid artery stenosis should be counseled on diet, exercise, moderation of alcohol consumption, smoking cessation, and avoidance of environmental tobacco smoke. Medical therapy generally includes a platelet antiaggregant, blood pressure control, and a statin. Other medical therapy depends on specific patient characteristics. Carotid endarterectomy in addition to best medical therapy is of proven benefit in reducing the risk of ipsilateral stroke compared with best medical therapy alone in patients with symptomatic high-grade stenosis, provided the operation can be performed safely. Although limited, data are available to support carotid angioplasty/stenting in patients with symptomatic high-grade stenosis in whom endarterectomy is not feasible because of anatomic or other technical factors. Whether carotid angioplasty/stenting is as efficacious as endarterectomy in patients with average periprocedural risk remains uncertain and is under investigation.