Abstract
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention in carotid stenosis. This review updates the indications and procedural technique of CAS up to 2026, based on the 2024 ESC guidelines, the 2024 CIRSE standards of practice, and recently published trials and registries. CREST-2 showed that, in asymptomatic stenosis ≥70%, CAS plus intensive medical management reduced 4-year stroke compared with medical management alone (2.8% vs 6.0%); ECST-2 found no benefit in low-risk patients. The technique is described step by step - assessment of the aortic arch and lesion, access, catheter selection and guiding placement, cerebral protection, balloon angioplasty and stenting - and illustrated with angiographic images and a clinical case. Micromesh stents, integrated protection and transcarotid revascularisation with flow reversal achieved 30-day event rates of 0.6-2.3%. Further randomised trials of new techniques are needed. CAS is effective when properly indicated and performed according to a standardised protocol.
