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(Circulation. 2006;113:2021-2030.)
© 2006 American Heart Association, Inc.

New Drugs and Technology

Realizing the Potential of Carotid Artery Stenting

Proposed Paradigms for Patient Selection and Procedural Technique

Gary S. Roubin, MD, PhD; Sriram Iyer, MD; Amir Halkin, MD; Jiri Vitek, MD; Christina Brennan, MD

From Lenox Hill Hospital, New York City, NY.

Correspondence to Dr Gary S. Roubin, Department of Cardiac and Vascular Interventional Services, Lenox Hill Heart and Vascular Institute, 9th Floor-Black Hall, Lenox Hill Hospital, 130E 77th St, New York, NY 10021.

Carotid artery stenting, compared with carotid endarterectomy, is emerging as an effective and less invasive method of revascularization for extracranial carotid artery stenosis. Carotid stenting is established as the treatment of choice for certain high-risk patient subsets, and ongoing clinical trials are evaluating this method across a broader clinical spectrum, including asymptomatic patients. For carotid stenting to reach its full potential, an acceptable risk of periprocedural complications, particularly in low-risk patients, must be ensured (the "3% rule"). The present article provides an in-depth review of carotid stenting, with special emphasis on the process of risk stratification pertaining to clinical, anatomic, and procedural considerations necessary to optimize procedural safety and patient outcomes.

Key Words: carotid arteries • prevention • prognosis • stents • stroke

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