Pre-Procedural Evaluation and Peri-Procedural Management in Carotid Artery Stenting

ABSTRACT

Carotid-artery stenting (CAS) is as an alternative to surgical endarterectomy for severe carotid-artery stenosis. CAS is advantageous over carotid endarterectomy in that it is less invasive and could shorten the hospital stay. A preprocedural evaluation is necessary to assess the patient's anatomic status or clinical risk factors to determine whether they are a good candidate for CAS. Proper evaluation and management can reduce CAS-associated complications such as embolism and cerebral hyperperfusion syndrome. The frequent use of statins appears to improve the outcome of CAS. Using the appropriate stent type and a protection device could also reduce the complication rate. Given the changes in cerebral hemodynamics following CAS, adequately controlling the blood pressure in individual patients can enhance the efficacy of this treatment. However, there is currently limited data regarding the preprocedural evaluation and periprocedural management for CAS. The evidence and the clinical status related to the preprocedural evaluation and periprocedural management of CAS are presented herein.