Carotid artery stenting in arteriosclerotic stenoses

The arteriosclerotic disease of the carotid arteries is one of the most important causes of ischaemic stroke. The annual number of patients treated with carotid artery stenting (CAS) or carotid endarterectomy (CEA) in Germany is 30000. Since the development of carotid artery stenting in the late 1980s the discussion of risk and benefit compared to the established carotid endarterectomy (CEA) is still ongoing. The most recent randomized prospective multinational multicentre trials (EVA-3S, SPACE I and preliminary results of the ICSS trial) failed to show inferiority of CAS vs. CEA. Though the data from these trials show important effects of the stenting technique and the stent design as well as expertise of the centres on periinterventional complication rates. The knowledge provided by these data is that selection of the therapy centre seems to be more important than the interventional or operative technique. Therefore the decision for or against one or the other procedure should be made in a consensus with neurologists, interventional neuro-radiologists and vascular surgeons under certain respect of the patients wish.