Neurointervention · IR Playbook

Carotid Artery Stenting (CAS)

Carotid artery stenting is the percutaneous placement of a self-expanding stent across an atherosclerotic stenosis at the carotid bifurcation to prevent ipsilateral ischaemic stroke. It works by trapping the plaque against the arterial wall and scaffolding it, so the aim is complete plaque coverage rather than maximal luminal gain — and the whole complication profile follows from this: every wire, balloon and stent pass across a loaded plaque can shower debris into the brain, every balloon inflation stretches the carotid bulb baroreceptors and drops heart rate and blood pressure, and suddenly restoring normal pressure to a chronically underperfused hemisphere can cause hyperperfusion and haemorrhage. In CREST, periprocedural stroke was higher with stenting than endarterectomy (4.1% versus 2.3%) while myocardial infarction was lower (1.1% versus 2.3%), and at 10 years the two procedures were equivalent for the composite endpoint. Cerebral hyperperfusion syndrome is reported in about 4.6% of stented patients and typically declares itself around 12 hours after the case.

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