Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. CAS is used to treat narrowing of the carotid artery in high-risk patients, when carotid endarterectomy is considered too risky. Carotid stenting is used to reduce the risk of stroke associated with carotid artery stenosis. Carotid stenosis can present with no symptoms or with symptoms such as transient ischemic attacks or strokes.

While historically endarterectomy has been the treatment for carotid stenosis, stenting is an alternative intervention for patients who are not candidates for surgery. High risk factors for endarterectomy, which would favor stenting instead, include medical comorbidities and anatomic features that would make surgery difficult and risky. Carotid stenting involves the placement of a stent across the stenosis in the carotid artery. It can be performed under general or local anesthesia.

The stent may be placed from the femoral artery or from the common carotid artery at the base of the neck. Critical steps in both approaches are vascular access, crossing the stenosis with a wire, deploying a stent across the lesion, and removing the vascular access. A number of other steps may or may not be performed, including the use of a cerebral protection device, pre- or post-stent balloon angioplasty and cerebral angiography. The trans-femoral route is the traditional approach to carotid stenting. In this technique, the femoral artery is used to gain access to the arterial system. Wire and sheath are advanced through the aorta to the common carotid artery on the side to be treated. Flow reversal or filter cerebral protection may be used. The procedure is typically performed percutaneously.

Recovery following carotid stenting is simple provided no complications occur. Patients typically leave the hospital in 0–1 days. The blood pressure is kept at a goal below 140 mmHg systolic. Elevated blood pressure in the 2–10 days post-operatively may lead to reperfusion syndrome.

The most feared short-term complication of any stroke prevention procedure on the carotid artery is stroke itself. Patients must be selected for surgery or stenting such that the long-term risk reduction of the procedure is greater than the short term risk assumed with the procedure of causing a stroke at the time of the procedure. Other short term complications include bleeding, infection and heart problems such as myocardial infarction related to anesthesia.

Journal of Imaging and Interventional Radiology is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of interventional radiology.
Each issue in Journal of Imaging and Interventional Radiology covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field. The journal is a medium for original articles, reviews, pictorial essays, technical notes and case reports related to all fields of interventional radiology. Manuscripts can be submitted to online at https://www.imedpub.com/submissions/imaging-interventional-radiology.html or an attachment to mail: radiology@emedscholar.comBest wishes

Ann Jose

Journal coordinator

Journal of Imaging and Interventional Radiology

intervradiology@longdomjournal.org