Technical Aspects of Carotid Artery Stenting

  • Robert G. Molnar
  • Nitin G. Malhotra


As carotid artery stenting (CAS) is approved for use in high surgical risk patients with symptomatic carotid artery occlusive disease and is being evaluated for use in standard risk, asymptomatic patients, the technical aspects of performing this procedure safely must be taught and disseminated. The consequences of embolization or thrombosis to the cerebral vasculature can be much more devastating than in other vascular beds treated via endovascular means. Therefore, the delineation of a safe and effective approach to CAS is evident, and attention to a meticulous approach to patient selection and procedural performance is extremely important. Even minor technical errors may lead to complications that significantly increase morbidity and mortality, the most feared of which is acute stroke. By applying appropriate patient selection and adhering to a best practice approach to the conduct of the procedure, complications can be avoided and morbidity and mortality minimized. In addition, having techniques identified for potential procedural complications can lead to salvage maneuvers that decrease potential morbidity and mortality. This chapter will review our best practice approach to CAS and hopefully add to your knowledge, perspective, and clinical approach to patients with carotid occlusive disease.


Carotid artery stenting High risk Symptomatic Asymptomatic Technical Stroke Morbidity Mortality Best practice Complications Patient selection Carotid artery disease Embolization Thrombosis 


  1. 1.
    Brott TG, Hobson RW II, Howard G, Roubin GS, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.CrossRefGoogle Scholar
  2. 2.
    Hobson RW, Howard VJ, Roubin GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in CREST lead-in phase. J Vasc Surg. 2004;40(6):1106–11.CrossRefGoogle Scholar
  3. 3.
    Kowlek CJ, Jaff MR, Leal JI, Hopkins LN, Shah RM, Hanover TM, Macdonald S, Canbria RP. Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg. 2015;62:1227–35.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Robert G. Molnar
    • 1
  • Nitin G. Malhotra
    • 1
  1. 1.Division of Vascular Surgery, Michigan Vascular CenterMcLaren Regional Medical Center, Michigan State UniversityFlintUSA

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