Percutaneous versus surgical revascularization for symptomatic carotid artery disease.

Stroke is the third leading cause of death worldwide and the number one disease associated with permanent disability. In 2006, the estimated total cost of stroke in the United States was a staggering $60 billion. Significant stenosis of the internal carotid artery is responsible for 10% to 20% of all strokes, and current recommendations suggest that patients with symptomatic carotid artery stenosis undergo revascularization for stroke prevention or risk reduction. Since the 1950s, carotid endarterectomy (CEA) has been the dominant modality of revascularization. However, carotid artery angioplasty, introduced in the 1980s, and subsequent carotid artery stenting (CAS), have greatly improved in recent years and provide a viable alternative to CEA, particularly for certain high-risk patients. Encouraging results from clinical studies of CAS and CEA have played pivotal roles in shaping current practice guidelines. We review the published studies on CAS and discuss appropriate use of this procedure for symptomatic carotid artery disease.