Technique Balloon angioplasty is presently used in recurrent disease after CEA or CAS and in non-atherosclerotic carotid artery stenosis. In symptomatic patients with a more than 70% atherosclerotic stenosis combining balloon angioplasty and stent placement gives better primary results and long-term patency. For stenting a variety of nitinol stents and the Wallstent are available. For cerebral protection balloons and filters are used.

Results In a series of more than 2,000 CAS from 1984 to 2003 a success rate of 99% was achieved accompanied by a complication rate of stroke and death of 3.6%. From 1999 to 2003 the technical success rate remained unchanged in 686 treatments with cerebral protection, but the complication rate (1.6%) could be reduced. A death rate of 0.26%, a rate of major stroke of 0.52% and of minor stroke of 0.78% prove the efficacy of cerebral protection. The 5-year patency is comparable to CEA with about 90%. Early reocclusions rarely happen, but can be prevented by a medication with clopidogrel and aspirin. Even with cerebral protection diffusion-weighted MR-imaging showed new, but less signal-intensive spots in otherwise asymptomatic patients. Intimal proliferation after CAS is rarely seen and only treated in symptomatic patients.

Learning Objectives

- Know indications for CAS

- Become familiar with devices and technique