title: Carotid artery stenting for primary and secondary stroke prevention.
abstract: BACKGROUND
  Carotid artery disease is a major cause of the disability and mortality associated with strokes. Ischemic stroke remains the major cause of adult disability and third-leading cause of adult mortality, and carotid revascularization currently remains the principal surgical tool in the prophylaxis of this disease.
  
  
  METHODS
  The literature representing the current body of evidence for carotid revascularization and the authors' current practices in the management of this disease are summarized in this review.
  
  
  RESULTS
  We provide an evidence-based narration of the development and current status of carotid artery stenting (CAS) by reviewing 1) the evidence for carotid revascularization from early carotid endarterectomy (CEA) trials; 2) the randomized trials comparing CEA and CAS, with a special emphasis on the recently published results of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which have been a "game-changer," tipping the balance towards accepting CAS as a safe, equally effective, and durable alternative to CEA for all patients requiring carotid revascularization; and 3) the technical advances in CAS after enrollment of patients in the CREST.
  
  
  CONCLUSIONS
  CAS and CEA are complementary procedures. Judicious selection of the procedure is made on a case-by-case basis.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA. asiddiqui@ubns.com
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
mesh_terms: D000367:Age Factors; D002170:Canada; D002339:Carotid Arteries / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002548:Cerebral Revascularization; D002986:Clinical Trials as Topic; D004867:Equipment Design; D005060:Europe; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D011322:Primary Prevention; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012306:Risk; D055502:Secondary Prevention; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014481:United States; D014486:United States Food and Drug Administration