Atherosclerotic disease of the carotid bifurcation is associated with an increased risk of both stroke and transient ischaemic attack. Carotid artery stenting (CAS) offers an alternative approach to carotid endarterectomy (CEA) in both symptomatic and asymptomatic individuals. The National Institute for Health and Clinical excellence (NICE) guidance for CAS in symptomatic subjects supports CAS with some caveats. The procedure should be carried out by an experienced clinical team with a good track record and there should be careful attention to audit and long-term follow-up. The case for CAS in asymptomatic carotid artery stenosis is not yet proved. For asymptomatic disease, NICE recommends that where CEA and CAS are clinically appropriate and technically feasible, patients should be randomised within the second Asymptomatic Carotid Surgery Trial (ACST-2).
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Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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