Carotid Endarterectomy Versus Stent In Carotid Artery Stenosis

The purpose of carotid revascularization is stroke prevention. The merits of carotid revascularization as well as the type of revascularization are dependent on the “natural risk” and the “revascularization risk.” In general, the natural risk of stroke in any patient with carotid stenosis (CS) is dependent on the symptomatic status of the patient and CS severity.Experience to date suggests that IVUS can safely yield imaging information complementary to contrast angiography, and although incomplete stent expansion or small postprocedural stent diameter may be associated with a greater risk of restenosis, the use of IVUS has not been proven to improve outcomes, reduce periprocedural stroke rates, or prevent restenosis. Although the technique has been used safely in a small series of patients undergoing carotid intervention, the additional catheter manipulation required to traverse stenotic lesions carries risk, and more evidence demonstrating benefit is needed before the incremental risk associated with IVUS can be justified as the basis for recommendations regarding routine use of this technology in patients undergoing endovascular evaluation and treatment of ECVD.(10)