Carotid stenting dilation and cerebral angiography. Carotid stenting is the preferred therapy for patients who are at an increased risk with carotid surgery. High risk factors include medical comorbidities (severe heart disease, heart failure, severe lung disease, age > 75/80, etc.) and anatomic features (contralateral carotid occlusion, radiation therapy to the neck, prior ipsilateral carotid artery surgery, intra-thoracic or intracranial carotid disease) that make surgery difficult or risky. Anatomic high surgical risk: Co-morbid high surgical risk: Using the criteria of successful trials, candidates are either symptomatic (TIA or stroke) patients with >50% stenosis of the carotid artery, or are asymptomatic with >80%
Carotid artery stenosis severe carotid artery stenosis, carotid endarterectomy reduces the risk of stroke in the next 5 years by 50%, though this represents a reduction in absolute incidence of all strokes or perioperative death of approximately 6%. In most centres, carotid endarterectomy is associated with a 30-day stroke or mortality rate of < 3%; some areas have higher rates. NICE and other guidelines also recommend that patients with "symptomatic" carotid stenosis be given carotid endarterectomy urgently, since the greatest risk of stroke is within days. Carotid endarterectomy reduces the risk of stroke or death from carotid emboli by about half. For people