Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Carotid artery stenting and its complications

Emile R Mohler III, MD
Ronald M Fairman, MD
Section Editors
Scott E Kasner, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


The proximal internal carotid artery and the carotid bifurcation are the locations most frequently affected by carotid atherosclerosis. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. This process can lead to transient ischemic attack or stroke from arterial embolization, or thrombosis, or less commonly from hemodynamic compromise. Treatment options for carotid occlusive disease include medical management, carotid endarterectomy, and carotid angioplasty and stenting.

This topic will review procedural aspects of carotid artery stenting (CAS), including early and late complications. Other treatment options are reviewed elsewhere. (See "Management of symptomatic carotid atherosclerotic disease" and "Management of asymptomatic carotid atherosclerotic disease" and "Carotid endarterectomy".)


The left common carotid artery (CCA) originates from the aortic arch, whereas the right CCA originates from the innominate artery (figure 1). The CCA divides into the internal carotid artery (ICA) and external carotid artery (ECA) at the level of the superior border of the thyroid cartilage corresponding to the C3/C4 disc space.

External carotid artery — The ECA has multiple branches that supply the face and scalp and provide collateral circulation to the brain. These branches include (caudal to cranial) the superior thyroid, lingual, facial, ascending pharyngeal, occipital, posterior auricular, maxillary, and superficial temporal arteries.

Internal carotid arteryThe ICA has no branches in the neck. The cervical segment of the internal carotid extends from the carotid bifurcation until it enters the carotid canal anterior to the jugular foramen. Detailed surgical anatomy of the internal carotid artery is described elsewhere. (See "Carotid endarterectomy", section on 'Internal carotid artery'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 5, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Kumamaru H, Jalbert JJ, Nguyen LL, et al. Surgeon case volume and 30-day mortality after carotid endarterectomy among contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting. Stroke 2015; 46:1288.
  2. Meschia JF, Hopkins LN, Altafullah I, et al. Time From Symptoms to Carotid Endarterectomy or Stenting and Perioperative Risk. Stroke 2015; 46:3540.
  3. De Rango P, Brown MM, Chaturvedi S, et al. Summary of Evidence on Early Carotid Intervention for Recently Symptomatic Stenosis Based on Meta-Analysis of Current Risks. Stroke 2015; 46:3423.
  4. Henry M, Gopalakrishnan L, Rajagopal S, et al. Bilateral carotid angioplasty and stenting. Catheter Cardiovasc Interv 2005; 64:275.
  5. Mathur A, Roubin GS, Iyer SS, et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998; 97:1239.
  6. Diehm N, Katzen BT, Iyer SS, et al. Staged bilateral carotid stenting, an effective strategy in high-risk patients - insights from a prospective multicenter trial. J Vasc Surg 2008; 47:1227.
  7. Liu S, Jung JH, Kim SM, et al. Simultaneous bilateral carotid stenting in high-risk patients. AJNR Am J Neuroradiol 2010; 31:1113.
  8. White CJ, Ramee SR, Collins TJ, et al. Carotid stents to prevent stroke: a nonsurgical option. Ochsner J 2003; 5:18.
  9. Hawkins BM, Kennedy KF, Giri J, et al. Pre-procedural risk quantification for carotid stenting using the CAS score: a report from the NCDR CARE Registry. J Am Coll Cardiol 2012; 60:1617.
  10. Hoke M, Ljubuncic E, Steinwender C, et al. A validated risk score to predict outcomes after carotid stenting. Circ Cardiovasc Interv 2012; 5:841.
  11. Wimmer NJ, Yeh RW, Cutlip DE, Mauri L. Risk prediction for adverse events after carotid artery stenting in higher surgical risk patients. Stroke 2012; 43:3218.
  12. Antonius Carotid Endaterectomy, Angioplasty, and Stenting Study Group. Transcranial Doppler monitoring in angioplasty and stenting of the carotid bifurcation. J Endovasc Ther 2003; 10:702.
  13. Tulip HH, Rosero EB, Higuera AJ, et al. Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting. J Vasc Surg 2012; 56:1579.
  14. Montorsi P, Caputi L, Galli S, et al. Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 2011; 58:1656.
  15. Bijuklic K, Wandler A, Varnakov Y, et al. Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv 2013; 6:311.
  16. Gröschel K, Ernemann U, Schnaudigel S, et al. A risk score to predict ischemic lesions after protected carotid artery stenting. J Neurol Sci 2008; 273:112.
  17. Rosenkranz M, Thomalla G, Havemeister S, et al. Older age and greater carotid intima-media thickness predict ischemic events associated with carotid-artery stenting. Cerebrovasc Dis 2010; 30:567.
  18. Timaran CH, Rosero EB, Martinez AE, et al. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 2010; 52:1188.
  19. Stojanov D, Ilic M, Bosnjakovic P, et al. New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology. AJNR Am J Neuroradiol 2012; 33:708.
  20. Almekhlafi MA, Demchuk AM, Mishra S, et al. Malignant emboli on transcranial Doppler during carotid stenting predict postprocedure diffusion-weighted imaging lesions. Stroke 2013; 44:1317.
  21. Gensicke H, Zumbrunn T, Jongen LM, et al. Characteristics of ischemic brain lesions after stenting or endarterectomy for symptomatic carotid artery stenosis: results from the international carotid stenting study-magnetic resonance imaging substudy. Stroke 2013; 44:80.
  22. Zhou W, Hitchner E, Gillis K, et al. Prospective neurocognitive evaluation of patients undergoing carotid interventions. J Vasc Surg 2012; 56:1571.
  23. Bijuklic K, Wandler A, Tübler T, Schofer J. Impact of asymptomatic cerebral lesions in diffusion-weighted magnetic resonance imaging after carotid artery stenting. JACC Cardiovasc Interv 2013; 6:394.
  24. SPACE Collaborative Group, Ringleb PA, Allenberg J, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006; 368:1239.
  25. Voeks JH, Howard G, Roubin GS, et al. Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke 2011; 42:3484.
  26. Hobson RW 2nd, Howard VJ, Roubin GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg 2004; 40:1106.
  27. Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363:11.
  28. Roubin GS, New G, Iyer SS, et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis. Circulation 2001; 103:532.
  29. Hofmann R, Niessner A, Kypta A, et al. Risk score for peri-interventional complications of carotid artery stenting. Stroke 2006; 37:2557.
  30. Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke 2010; 41:757.
  31. Antoniou GA, Georgiadis GS, Georgakarakos EI, et al. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg 2013; 148:1140.
  32. Jalbert JJ, Nguyen LL, Gerhard-Herman MD, et al. Outcomes after carotid artery stenting in Medicare beneficiaries, 2005 to 2009. JAMA Neurol 2015; 72:276.
  33. Lam RC, Lin SC, DeRubertis B, et al. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg 2007; 45:875.
  34. Rockman CB, Garg K, Jacobowitz GR, et al. Outcome of carotid artery interventions among female patients, 2004 to 2005. J Vasc Surg 2011; 53:1457.
  35. Howard VJ, Lutsep HL, Mackey A, et al. Influence of sex on outcomes of stenting versus endarterectomy: a subgroup analysis of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Lancet Neurol 2011; 10:530.
  36. Vouyouka AG, Egorova NN, Sosunov EA, et al. Analysis of Florida and New York state hospital discharges suggests that carotid stenting in symptomatic women is associated with significant increase in mortality and perioperative morbidity compared with carotid endarterectomy. J Vasc Surg 2012; 56:334.
  37. Bisdas T, Egorova N, Moskowitz AJ, et al. The impact of gender on in-hospital outcomes after carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg 2012; 44:244.
  38. Qureshi AI, Luft AR, Janardhan V, et al. Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting. Stroke 2000; 31:376.
  39. Voeks JH, Howard G, Roubin G, et al. Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 2015; 46:2868.
  40. Mercado N, Cohen DJ, Spertus JA, et al. Carotid artery stenting of a contralateral occlusion and in-hospital outcomes: results from the CARE (Carotid Artery Revascularization and Endarterectomy) registry. JACC Cardiovasc Interv 2013; 6:59.
  41. Dorresteijn LD, Vogels OJ, de Leeuw FE, et al. Outcome of carotid artery stenting for radiation-induced stenosis. Int J Radiat Oncol Biol Phys 2010; 77:1386.
  42. Shawl FA. Carotid artery stenting: acute and long-term results. Curr Opin Cardiol 2002; 17:671.
  43. Al-Mubarak N, Roubin GS, Iyer SS, et al. Carotid stenting for severe radiation-induced extracranial carotid artery occlusive disease. J Endovasc Ther 2000; 7:36.
  44. Shin SH, Stout CL, Richardson AI, et al. Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis. J Vasc Surg 2009; 50:762.
  45. Protack CD, Bakken AM, Saad WE, et al. Radiation arteritis: a contraindication to carotid stenting? J Vasc Surg 2007; 45:110.
  46. Skelly CL, Gallagher K, Fairman RM, et al. Risk factors for restenosis after carotid artery angioplasty and stenting. J Vasc Surg 2006; 44:1010.
  47. Tallarita T, Oderich GS, Lanzino G, et al. Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis. J Vasc Surg 2011; 53:629.
  48. Eskandari MK, Brown KE, Kibbe MR, et al. Restenosis after carotid stent placement in patients with previous neck irradiation or endarterectomy. J Vasc Interv Radiol 2007; 18:1368.
  49. Fokkema M, den Hartog AG, Bots ML, et al. Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy: systematic review and meta-analysis. Stroke 2012; 43:793.
  50. Kasivisvanathan V, Thapar A, Davies KJ, et al. Periprocedural outcomes after surgical revascularization and stenting for postradiotherapy carotid stenosis. J Vasc Surg 2012; 56:1143.
  51. Ederle J, Davagnanam I, van der Worp HB, et al. Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): a prespecified analysis of data from a randomised trial. Lancet Neurol 2013; 12:866.
  52. Kastrup A, Gröschel K, Schulz JB, et al. Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid angioplasty and stenting. Stroke 2005; 36:787.
  53. Jackson BM, English SJ, Fairman RM, et al. Carotid artery stenting: identification of risk factors for poor outcomes. J Vasc Surg 2008; 48:74.
  54. Reimers B, Schlüter M, Castriota F, et al. Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med 2004; 116:217.
  55. Howard VJ, Voeks JH, Lutsep HL, et al. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase. Stroke 2009; 40:1140.
  56. Donahue M, Visconti G, Focaccio A, et al. Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Internal Carotid Artery Stent Implantation. JACC Cardiovasc Interv 2015; 8:1506.
  57. Faggioli G, Pini R, Rapezzi C, et al. Carotid revascularization in patients with ongoing oral anticoagulant therapy: the advantages of stent placement. J Vasc Interv Radiol 2013; 24:370.
  58. Matas M, Domínguez González JM, Montull E. Antiplatelet therapy in endovascular surgery: the RENDOVASC study. Ann Vasc Surg 2013; 27:168.
  59. Huibers A, Halliday A, Bulbulia R, et al. Antiplatelet Therapy in Carotid Artery Stenting and Carotid Endarterectomy in the Asymptomatic Carotid Surgery Trial-2. Eur J Vasc Endovasc Surg 2016; 51:336.
  60. Patti G, Tomai F, Melfi R, et al. Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) study. J Am Coll Cardiol 2013; 61:1379.
  61. Van Der Heyden J, Van Werkum J, Hackeng CM, et al. High versus standard clopidogrel loading in patients undergoing carotid artery stenting prior to cardiac surgery to assess the number of microemboli detected with transcranial Doppler: results of the randomized IMPACT trial. J Cardiovasc Surg (Torino) 2013; 54:337.
  62. Galyfos G, Geropapas G, Sigala F, et al. Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting. J Endovasc Ther 2016; 23:186.
  63. Tadros RO, Vouyouka AG, Chung C, et al. The effect of statin use on embolic potential during carotid angioplasty and stenting. Ann Vasc Surg 2013; 27:96.
  64. Giri J, Kennedy KF, Weinberg I, et al. Comparative effectiveness of commonly used devices for carotid artery stenting: an NCDR Analysis (National Cardiovascular Data Registry). JACC Cardiovasc Interv 2014; 7:171.
  65. Nikas DN, Kompara G, Reimers B. Carotid stents: which is the best option? J Cardiovasc Surg (Torino) 2011; 52:779.
  66. White CJ. Carotid artery stenting. J Am Coll Cardiol 2014; 64:722.
  67. Tadros RO, Spyris CT, Vouyouka AG, et al. Comparing the embolic potential of open and closed cell stents during carotid angioplasty and stenting. J Vasc Surg 2012; 56:89.
  68. Kouvelos GN, Patelis N, Antoniou GA, et al. Meta-analysis of the Effect of Stent Design on 30-Day Outcome After Carotid Artery Stenting. J Endovasc Ther 2015; 22:789.
  69. Mousa AY, Campbell JE, Aburahma AF, Bates MC. Current update of cerebral embolic protection devices. J Vasc Surg 2012; 56:1429.
  70. Bonati LH, Lyrer P, Ederle J, et al. Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev 2012; :CD000515.
  71. Bornak A, Milner R. Current debate on the role of embolic protection devices. Vasc Endovascular Surg 2012; 46:441.
  72. Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 2012; 59:1383.
  73. Matsumura JS, Gray W, Chaturvedi S, et al. Results of carotid artery stenting with distal embolic protection with improved systems: Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy (PROTECT) trial. J Vasc Surg 2012; 55:968.
  74. Macdonald S. The evidence for cerebral protection: an analysis and summary of the literature. Eur J Radiol 2006; 60:20.
  75. Garg N, Karagiorgos N, Pisimisis GT, et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther 2009; 16:412.
  76. Macdonald S. New embolic protection devices: a review. J Cardiovasc Surg (Torino) 2011; 52:821.
  77. Macdonald S. Embolic protection in carotid artery stenting: "a no-brainer"? J Cardiovasc Surg (Torino) 2010; 51:861.
  78. Giri J, Parikh SA, Kennedy KF, et al. Proximal versus distal embolic protection for carotid artery stenting: a national cardiovascular data registry analysis. JACC Cardiovasc Interv 2015; 8:609.
  79. Giugliano G, Stabile E, Biamino G, et al. Predictors of carotid occlusion intolerance during proximal protected carotid artery stenting. JACC Cardiovasc Interv 2014; 7:1237.
  80. Stabile E, Sannino A, Schiattarella GG, et al. Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion. JACC Cardiovasc Interv 2014; 7:1177.
  81. Brown MM. Carotid artery stenting--evolution of a technique to rival carotid endarterectomy. Am J Med 2004; 116:273.
  82. Ansel GM, Hopkins LN, Jaff MR, et al. Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 2010; 76:1.
  83. Clair DG, Hopkins LN, Mehta M, et al. Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE Clinical Study. Catheter Cardiovasc Interv 2011; 77:420.
  84. Pinter L, Ribo M, Loh C, et al. Safety and feasibility of a novel transcervical access neuroprotection system for carotid artery stenting in the PROOF Study. J Vasc Surg 2011; 54:1317.
  85. Kwolek CJ, Jaff MR, Leal JI, et al. Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg 2015; 62:1227.
  86. Bersin RM, Stabile E, Ansel GM, et al. A meta-analysis of proximal occlusion device outcomes in carotid artery stenting. Catheter Cardiovasc Interv 2012; 80:1072.
  87. Castro-Afonso LH, Abud LG, Rolo JG, et al. Flow reversal versus filter protection: a pilot carotid artery stenting randomized trial. Circ Cardiovasc Interv 2013; 6:552.
  88. Goode SD, Hoggard N, Macdonald S, et al. Assessment of reverse flow as a means of cerebral protection during carotid artery stent placement with diffusion-weighted and transcranial Doppler imaging. J Vasc Interv Radiol 2013; 24:528.
  89. Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355:1660.
  90. Bonati LH, Jongen LM, Haller S, et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9:353.
  91. Ederle J, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev 2007; :CD000515.
  92. Zahn R, Mark B, Niedermaier N, et al. Embolic protection devices for carotid artery stenting: better results than stenting without protection? Eur Heart J 2004; 25:1550.
  93. Eckert B, Zeumer H. Editorial comment--Carotid artery stenting with or without protection devices? Strong opinions, poor evidence! Stroke 2003; 34:1941.
  94. Theron JG, Payelle GG, Coskun O, et al. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement. Radiology 1996; 201:627.
  95. Henry M, Amor M, Henry I, et al. Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg 1999; 6:321.
  96. Reimers B, Corvaja N, Moshiri S, et al. Cerebral protection with filter devices during carotid artery stenting. Circulation 2001; 104:12.
  97. Al-Mubarak N, Roubin GS, Vitek JJ, et al. Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation 2001; 104:1999.
  98. Al-Mubarak N, Colombo A, Gaines PA, et al. Multicenter evaluation of carotid artery stenting with a filter protection system. J Am Coll Cardiol 2002; 39:841.
  99. Chan AW, Yadav JS, Bhatt DL, et al. Comparison of the safety and efficacy of emboli prevention devices versus platelet glycoprotein IIb/IIIa inhibition during carotid stenting. Am J Cardiol 2005; 95:791.
  100. Touzé E, Trinquart L, Chatellier G, Mas JL. Systematic review of the perioperative risks of stroke or death after carotid angioplasty and stenting. Stroke 2009; 40:e683.
  101. Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008; 39:1911.
  102. Gensicke H, van der Worp HB, Nederkoorn PJ, et al. Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol 2015; 65:521.
  103. Rapp JH, Wakil L, Sawhney R, et al. Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg 2007; 45:867.
  104. Vos JA, van den Berg JC, Ernst SM, et al. Carotid angioplasty and stent placement: comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 2005; 234:493.
  105. Tübler T, Schlüter M, Dirsch O, et al. Balloon-protected carotid artery stenting: relationship of periprocedural neurological complications with the size of particulate debris. Circulation 2001; 104:2791.
  106. Alvarez B, Matas M, Ribo M, et al. Transcervical carotid stenting with flow reversal is a safe technique for high-risk patients older than 70 years. J Vasc Surg 2012; 55:978.
  107. Leal I, Orgaz A, Flores Á, et al. A diffusion-weighted magnetic resonance imaging-based study of transcervical carotid stenting with flow reversal versus transfemoral filter protection. J Vasc Surg 2012; 56:1585.
  108. Sfyroeras GS, Moulakakis KG, Markatis F, et al. Results of carotid artery stenting with transcervical access. J Vasc Surg 2013; 58:1402.
  109. Matsuda Y, Terada T, Masuo O, et al. The clinical results of transcervical carotid artery stenting and frequency chosen as the approach route of carotid artery stenting in 1,067 consecutive cases. Acta Neurochir (Wien) 2013; 155:1575.
  110. Ortega G, Álvarez B, Quintana M, et al. Cognitive improvement in patients with severe carotid artery stenosis after transcervical stenting with protective flow reversal. Cerebrovasc Dis 2013; 35:124.
  111. Christopoulos D, Philippov E. The results of a simplified technique for safe carotid stenting in the elderly. J Vasc Surg 2011; 54:1637.
  112. Palombo G, Stella N, Faraglia V, et al. Cervical access for filter-protected carotid artery stenting: a useful tool to reduce cerebral embolisation. Eur J Vasc Endovasc Surg 2010; 39:252.
  113. Christopoulos D, Philippov E, Kallintzi M. Safe carotid artery angioplasty and stenting in patients unsuitable for transfemoral approach. Int Angiol 2010; 29:37.
  114. Flores A, Doblas M, Criado E. Transcervical carotid artery stenting with flow reversal eliminates emboli during stenting: why does it work and what are the advantages with this approach. J Cardiovasc Surg (Torino) 2009; 50:745.
  115. Faraglia V, Palombo G, Stella N, et al. Cerebral embolization during transcervical carotid stenting with flow reversal: a diffusion-weighted magnetic resonance study. Ann Vasc Surg 2009; 23:429.
  116. Criado E, Fontcuberta J, Orgaz A, et al. Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents. J Vasc Surg 2007; 46:864.
  117. Matas M, Alvarez B, Ribo M, et al. Transcervical carotid stenting with flow reversal protection: experience in high-risk patients. J Vasc Surg 2007; 46:49.
  118. Alexandrescu V, Ngongang C, Proumen J, et al. Filter-protected carotid stenting via a minimal cervical access with transitory aspirated reversed flow during initial passage of the target lesion. J Endovasc Ther 2006; 13:196.
  119. Lin JC, Kolvenbach RR, Pinter L. Protected carotid artery stenting and angioplasty via transfemoral versus transcervical approaches. Vasc Endovascular Surg 2005; 39:499.
  120. Pipinos II, Johanning JM, Pham CN, et al. Transcervical approach with protective flow reversal for carotid angioplasty and stenting. J Endovasc Ther 2005; 12:446.
  121. Lo CH, Doblas M, Criado E. Advantages and indications of transcervical carotid artery stenting with carotid flow reversal. J Cardiovasc Surg (Torino) 2005; 46:229.
  122. Criado E, Doblas M, Fontcuberta J, et al. Transcervical carotid stenting with internal carotid artery flow reversal: feasibility and preliminary results. J Vasc Surg 2004; 40:476.
  123. Chang DW, Schubart PJ, Veith FJ, Zarins CK. A new approach to carotid angioplasty and stenting with transcervical occlusion and protective shunting: Why it may be a better carotid artery intervention. J Vasc Surg 2004; 39:994.
  124. Kedev S, Petkoska D, Zafirovska B, et al. Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent. Am J Cardiol 2015; 116:977.
  125. Lorenzoni R, Roffi M. Transradial access for peripheral and cerebrovascular interventions. J Invasive Cardiol 2013; 25:529.
  126. Etxegoien N, Rhyne D, Kedev S, et al. The transradial approach for carotid artery stenting. Catheter Cardiovasc Interv 2012; 80:1081.
  127. Ruzsa Z, Nemes B, Pintér L, et al. A randomised comparison of transradial and transfemoral approach for carotid artery stenting: RADCAR (RADial access for CARotid artery stenting) study. EuroIntervention 2014; 10:381.
  128. Wayangankar SA, Abu-Fadel MS, Aronow HD, et al. Hemorrhagic and ischemic outcomes after bivalirudin versus unfractionated heparin during carotid artery stenting: a propensity score analysis from the NCDR. Circ Cardiovasc Interv 2013; 6:131.
  129. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 2001; 357:1729.
  130. Tan KT, Cleveland TJ, Berczi V, et al. Timing and frequency of complications after carotid artery stenting: what is the optimal period of observation? J Vasc Surg 2003; 38:236.
  131. Mylonas SN, Moulakakis KG, Antonopoulos CN, et al. Carotid artery stenting-induced hemodynamic instability. J Endovasc Ther 2013; 20:48.
  132. Qureshi AI, Luft AR, Sharma M, et al. Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting. Stroke 1999; 30:2086.
  133. Ullery BW, Nathan DP, Shang EK, et al. Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting. J Vasc Surg 2013; 58:917.
  134. Vincent S, Eberg M, Eisenberg MJ, Filion KB. Meta-Analysis of Randomized Controlled Trials Comparing the Long-Term Outcomes of Carotid Artery Stenting Versus Endarterectomy. Circ Cardiovasc Qual Outcomes 2015; 8:S99.
  135. Economopoulos KP, Sergentanis TN, Tsivgoulis G, et al. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke 2011; 42:687.
  136. International Carotid Stenting Study investigators, Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375:985.
  137. Gray WA, Chaturvedi S, Verta P, Investigators and the Executive Committees. Thirty-day outcomes for carotid artery stenting in 6320 patients from 2 prospective, multicenter, high-surgical-risk registries. Circ Cardiovasc Interv 2009; 2:159.
  138. Choi JC, Johnston SC, Kim AS. Early outcomes after carotid artery stenting compared with endarterectomy for asymptomatic carotid stenosis. Stroke 2015; 46:120.
  139. Nolan BW, De Martino RR, Goodney PP, et al. Comparison of carotid endarterectomy and stenting in real world practice using a regional quality improvement registry. J Vasc Surg 2012; 56:990.
  140. Mendelsohn FO, Weissman NJ, Lederman RJ, et al. Acute hemodynamic changes during carotid artery stenting. Am J Cardiol 1998; 82:1077.
  141. Gupta R, Abou-Chebl A, Bajzer CT, et al. Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting. J Am Coll Cardiol 2006; 47:1538.
  142. Lin PH, Zhou W, Kougias P, et al. Factors associated with hypotension and bradycardia after carotid angioplasty and stenting. J Vasc Surg 2007; 46:846.
  143. Park BD, Divinagracia T, Madej O, et al. Predictors of clinically significant postprocedural hypotension after carotid endarterectomy and carotid angioplasty with stenting. J Vasc Surg 2009; 50:526.
  144. Casserly IP, Abou-Chebl A, Fathi RB, et al. Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome. J Am Coll Cardiol 2005; 46:1466.
  145. Cremonesi A, Manetti R, Setacci F, et al. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke 2003; 34:1936.
  146. Timaran CH, Veith FJ, Rosero EB, et al. Intracranial hemorrhage after carotid endarterectomy and carotid stenting in the United States in 2005. J Vasc Surg 2009; 49:623.
  147. Abou-Chebl A, Yadav JS, Reginelli JP, et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol 2004; 43:1596.
  148. Khan A, Adil MM, Qureshi AI. Non-ST-elevation myocardial infarction in patients undergoing carotid endarterectomy or carotid artery stent placement. Stroke 2014; 45:595.
  149. Taha MM, Sakaida H, Asakura F, et al. Access site complications with carotid angioplasty and stenting. Surg Neurol 2007; 68:431.
  150. Roubin GS, Yadav S, Iyer SS, Vitek J. Carotid stent-supported angioplasty: a neurovascular intervention to prevent stroke. Am J Cardiol 1996; 78:8.
  151. Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: initial experience in 110 patients. J Endovasc Surg 1996; 3:42.
  152. Tong FC, Cloft HJ, Joseph GJ, et al. Abciximab rescue in acute carotid stent thrombosis. AJNR Am J Neuroradiol 2000; 21:1750.
  153. Chaturvedi S, Sohrab S, Tselis A. Carotid stent thrombosis: report of 2 fatal cases. Stroke 2001; 32:2700.
  154. Buhk JH, Wellmer A, Knauth M. Late in-stent thrombosis following carotid angioplasty and stenting. Neurology 2006; 66:1594.
  155. Lattimer CR, Burnand KG. Recurrent carotid stenosis after carotid endarterectomy. Br J Surg 1997; 84:1206.
  156. Willfort-Ehringer A, Ahmadi R, Gschwandtner ME, et al. Healing of carotid stents: a prospective duplex ultrasound study. J Endovasc Ther 2003; 10:636.
  157. Lal BK, Beach KW, Roubin GS, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol 2012; 11:755.
  158. Gröschel K, Riecker A, Schulz JB, et al. Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke 2005; 36:367.
  159. Frericks H, Kievit J, van Baalen JM, van Bockel JH. Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature. Stroke 1998; 29:244.
  160. Moore WS, Kempczinski RF, Nelson JJ, Toole JF. Recurrent carotid stenosis : results of the asymptomatic carotid atherosclerosis study. Stroke 1998; 29:2018.
  161. McCabe DJ, Pereira AC, Clifton A, et al. Restenosis after carotid angioplasty, stenting, or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). Stroke 2005; 36:281.
  162. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351:1493.
  163. Dorigo W, Pulli R, Fargion A, et al. Comparison of open and endovascular treatments of post-carotid endarterectomy restenosis. Eur J Vasc Endovasc Surg 2013; 45:437.
  164. Gurm HS, Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008; 358:1572.
  165. Bergeron P, Roux M, Khanoyan P, et al. Long-term results of carotid stenting are competitive with surgery. J Vasc Surg 2005; 41:213.
  166. Ling AJ, Mwipatayi P, Gandhi T, Sieunarine K. Stenting for carotid artery stenosis: fractures, proposed etiology and the need for surveillance. J Vasc Surg 2008; 47:1220.