Stenting of the extracranial, proximal internal carotid artery

Carotid artery stenting is an endoluminal revascularization procedure that is performed to manage stenosis and has therapeutic indications that are being constantly refined. As the understanding of carotid disease pathophysiology improves and the tools for its management evolve, the clinician continues to be faced with challenges regarding the appropriate therapeutic approach (carotid revascularization with stenting or endarterectomy, or best medical therapy), and in situations where the choice is less clear, careful consideration of other findings (i.e., cognition, plaque composition, cerebral perfusion), as will be discussed here, is needed. The management of symptomatic moderate carotid stenosis as well as asymptomatic disease remains fiercely debated. We consider management of these conditions, specifically in reference to cognitive findings, perfusion assessment, and plaque characterization. In addition, we present evolution in stenting strategies as well as optimal medical therapy