Abstract
Extracranial carotid artery stenosis is one of the leading causes of ischemic stroke, accounting for up to 15% of all causes. In these patients, the recurrence rate is up to 11.5% in the first 14 days without secondary prevention treatment. Therefore, in addition to optimal medical therapy, carotid artery revascularization plays an important role in preventing recurrent strokes in this population. In the early 1950s, DeBakey first performed carotid endarterectomy (CEA). Since then, CEA has been widely accepted as the standard treatment for carotid artery revascularization. Several clinical trials have demonstrated its superiority over optimal medical therapy alone in secondary prevention. More than two decades later, in 1981, Klaus Mathias first performed percutaneous balloon angioplasty of the carotid artery. Although the initial results were favorable, standalone balloon angioplasty had a high restenosis rate and could cause some complications such as carotid dissection and plaque embolization leading to stroke. Based on studies on the benefits of stents in coronary interventions, carotid artery stenting (CAS) soon replaced standalone balloon angioplasty. Since 1994, CAS has been applied as an alternative revascularization method to CEA in many clinical trials. Carotid stenting is less invasive than endarterectomy, while also reducing the risk of cranial nerve injury and neck hematoma. This method also has advantages over endarterectomy in patients with previous neck radiation, prior neck surgery, or difficult anatomical access (lesions in the very high carotid, common carotid lesions). Additionally, patients at high risk of cardiovascular complications from surgery may benefit from carotid stenting by avoiding myocardial infarction, a common complication after endarterectomy. Therefore, over the past 10 years, the use of CAS has increased and it is now a routine procedure at cardiovascular and neurological intervention centers worldwide and in Vietnam. This article aims to provide an overview of current carotid stenting practices and trends in future developments.
