What are the alternatives to surgical CEA?
Carotid artery angioplasty with or without placement of an arterial stent is a possible alternative treatment for carotid artery stenosis. This technique involves the endovascular placement of a catheter, usually from the femoral artery, with fluoroscopic guidance through the great arteries and heart to the carotid artery. A balloon is positioned in the area of the stenosis and inflated to dilate the artery. A filter or other device may be temporarily posi-tioned distal to the lesion in order to limit embolization of material to the brain. After angioplasty, a stent may be positioned at the site to maintain the patency of the artery. The safety and preference of angioplasty compared with surgical treatment is uncertain and controversial. It may be the only practical treatment for cases of high-grade carotid stenosis where the lesion is located distally near the cra-nium and, therefore, poorly accessible to surgery.