predictive of prolonged length of stay due to postoperative hypertension. Thus, we make an effort to have hypertension under control before proceeding with CAS [111]. (See "Anesthesia for carotid endarterectomy and carotid stenting", section on 'Hemodynamic monitoring'.) Prophyactic antibiotics Although not routinely recommended for all percutaneous interventional procedures, antibiotic prophylaxis prior to CAS is standard practice, regardless of approach. Appropriate antibiotic choices are given in the table ( table 1). Dual antiplatelet therapy Prior to CAS, we recommend pretreatment with dual antiplatelet therapy (DAPT) using aspirin and clopidogrel ( algorithm 1); however, data are limited regarding the effectiveness of DAPT; the optimal timing, dose and duration of treatment for CAS is unknown [112]. Our specific pretreatment and post-treatment dosing regimens for percutaneous CAS and TCAR are provided separately. (See "Percutaneous carotid artery stenting", section on 'Antiplatelet/statin therapy' and "Transcarotid artery revascularization", section on 'Dual antiplatelet therapy and statins'.) A systematic review identified only two small trials comparing single with dual antiplatelet therapy in patients undergoing CAS. In a meta-analysis of these two trials [113-115], the risk for transient ischemic attack (TIA) was reduced for dual compared with single antiplatelet therapy (1.3 versus 14.6 percent; risk difference -0.13; 95% CI -0.22 to -0.05). However, there were no differences in stroke, major bleeding, or hematoma formation, or incidence of MI or death. In a separate meta-analysis of these same trials, the risk for restenosis was similar [116]. In the absence of any other robust data, we initiate DAPT using aspirin and clopidogrel prior to the procedure (at least 48 hours for percutaneous CAS; the TCAR trial favored 72 hours pretreatment) and continue dual antiplatelet therapy post-procedure for at least four weeks. Thereafter, aspirin should be continued indefinitely to reduce the risk for future cardiovascular events. (See "Prevention of cardiovascular disease events in those with established disease (secondary prevention) or at very high risk", section on 'Antiplatelet therapy'.) In an observational study from the Vascular Quality Initiative looking at 31,036 total CAS procedures (approximately 50/50 TCAR and TF-CAS), perioperative P2Y12 inhibitors (clopidogrel, prasugrel, or ticagrelor taken within 36 hours of the procedure) markedly reduced the perioperative neurologic event rate [117]. Among patients on P2Y12 inhibitors, 92.7 percent were also taking aspirin. P2Y12 inhibitors were significantly more likely to be used in TCAR cases compared with TF-CAS cases (87.3 versus 76.8 percent). Of the patients on P2Y12 inhibitors, 77.3 https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 12/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate percent were on clopidogrel. This study demonstrated there is considerable room for improving compliance with recommended perioperative DAPT. For patients with a history of neck irradiation, we suggest long-term DAPT with aspirin and clopidogrel following CAS, provided the risk of bleeding remains low. While there are no studies available that have specifically evaluated such a protocol in this subset of patients, radiated patients are at high risk for recurrent carotid stenosis following CAS, as high as 30 percent in some series. In CAS trials, the following protocols were used: In the CREST trial, patients were treated with aspirin (325 mg twice daily) and clopidogrel (75 mg twice daily) starting at least 48 hours before the CAS procedure [4]. Those scheduled for CAS within 48 hours received aspirin 650 mg and clopidogrel 450 mg at least four hours before the CAS procedure. Following CAS, treatment included aspirin 325 mg once or twice daily and clopidogrel 75 mg daily (or ticlopidine 250 mg twice daily) for at least 30 days, with a recommendation to continue aspirin indefinitely (at least one year). In a survey of participants of the Asymptomatic Carotid Surgery Trial 2 (ACST2 trial), 82 percent of sites used dual antiplatelet therapy (DAPT) preoperatively and 86 percent postoperatively with a mean postprocedural duration of three months (range 1 to 12), while 9 percent continued DAPT lifelong [118]. For those prescribing postprocedural mono antiplatelet therapy (76 percent), aspirin was more commonly prescribed than clopidogrel (59 versus 6 percent), and 11 percent did not show a preference for either aspirin or clopidogrel. Eleven centers (16 percent) tested for antiplatelet therapy resistance. In the ROADSTER 2 study, early postoperative outcomes in the intention-to-treat population (692 patients) included stroke in 13 patients (1.9 percent), death in 3 patients (0.4 percent), and MI in 6 patients (0.9 percent) [88]. Sixty patients had major protocol deviations, and among these, 48 patients were not on dual antiplatelet and statin therapy while undergoing carotid intervention or during the periprocedural follow-up period. Among the 60 patients with protocol violations, perioperative (30-day) stroke occurred in 9 (26 percent); death in 2 (3.3 percent); MI in none. Guidelines have suggested a range of periprocedural aspirin therapy ranging from 75 mg to 325 mg daily [82,83,119,120]. Various loading doses of clopidogrel have also been used. Other doses of clopidogrel have also been investigated. In the Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting (ARMYDA-9 CAROTID) trial, 156 patients were randomly assigned to receive a loading dose of clopidogrel (600 mg or 300 mg) before stenting https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 13/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate with or without a statin reload (2 x 2 trial design) [121]. The perioperative (30-day) incidence of TIA/stroke or new ischemic lesions on magnetic resonance imaging was lowest in the 600 mg clopidogrel plus statin reload group. By contrast, in a smaller trial, no differences were seen between groups for asymptomatic patients (n = 35) undergoing CAS assigned to 300 mg or 600 mg of clopidogrel with respect to the sum of all microembolic signals on transcranial Doppler, or platelet aggregation measurements [122]. Cilostazol is a phosphodiesterase inhibitor that is commonly used in the treatment of claudication. A systematic literature review identified seven studies evaluating outcomes using cilostazol in association with CAS [123]. Major outcomes included in-stent restenosis within the observation period, revascularization rate, major/minor bleeding, and MI/stroke/death rate at 30 days and within the observation period. A significantly lower rate of in-stent stenosis was seen with cilostazol treatment after a mean follow-up of 20 months (odds ratio [OR] 0.158, 95% CI 0.072-0.349). No significant differences were found between the groups among five studies (649 patients) for periprocedural MI/stroke/death or in three studies (1076 patients) for MI/stroke/death for the entire follow-up period. Statin therapy Statin therapy is recommended for patients following TIA or ischemic stroke or in those with coronary artery disease risk equivalents. (See "Management of low density lipoprotein cholesterol (LDL-C) in the secondary prevention of cardiovascular disease" and "Overview of secondary prevention of ischemic stroke", section on 'LDL-C lowering therapy'.) Whether statin therapy can reduce the risk of cerebral embolization during or after CAS is debated [121,124-129]. A small study compared debris collected from embolic protection devices in 62 patients who were or were not taking statins [129]. Statin use (HMG-CoA-reductase inhibitor) was associated with significantly fewer embolic particles (16.4 versus 42.4 particles). Coronary artery disease, prior coronary artery bypass grafting, and hyperlipidemia were more prevalent in those receiving statins. The authors speculated that statin use stabilizes atherosclerotic plaque, resulting in a more fibrous plaque that is less vulnerable. Our specific pretreatment and post-treatment dosing regimens for percutaneous CAS and TCAR are provided separately. (See "Percutaneous carotid artery stenting", section on 'Antiplatelet/statin therapy' and "Transcarotid artery revascularization", section on 'Dual antiplatelet therapy and statins'.) Patients requiring long-term anticoagulation A decision to stop versus bridge long-term oral anticoagulation (OAC) prior to carotid stenting is individualized and made together with the patient's cardiologist or medical physician [130]. Regardless of whether OAC is continued or temporarily discontinued (with or without bridging anticoagulation), antiplatelet therapy (ie, https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 14/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate aspirin and clopidogrel) is initiated prior to the carotid procedure in the manner discussed above. (See 'Dual antiplatelet therapy' above and "Perioperative management of patients receiving anticoagulants".) Following carotid stenting, if OAC was temporarily discontinued, it is resumed and aspirin and clopidogrel initiated preoperatively are continued for at least four weeks, at which point aspirin is discontinued while clopidogrel is continued along with the anticoagulation. Any new ischemic or bleeding episodes (or change in bleeding risk) should lead to a re-evaluation of antithrombotic therapy. This approach is based on outcomes from coronary stenting. There are no data to suggest that a different approach is warranted when performing a carotid stent. (See "Coronary artery disease patients requiring combined anticoagulant and antiplatelet therapy", section on 'Our approach'.) Outcomes from studies of percutaneous coronary procedures with or without stenting also do not demonstrate any increase in adverse outcomes for uninterrupted compared with interrupted OAC, suggesting that continuing OACs is safe [131,132]. In one retrospective review of patients undergoing CAS, among 502 patients, there were 20 patients who did not discontinue OACs. There were no complications in this group [133]. In another review that included 511 CAS procedures, among 30 patients taking OACs, outcomes were similar to those not taking OACs [30]. Postprocedure care and duplex surveillance Postprocedure care following CAS is similar to that following carotid endarterectomy [111]. (See "Carotid endarterectomy", section on 'Postoperative care'.) Patients are transferred to a monitored setting for frequent blood pressure and neurologic assessment. CAS is associated with a slightly higher rate of postprocedural hypotension compared with CEA, likely related to the continued outward force of the implanted stent on the carotid body [109,110]. As such, measures should be taken to closely monitor for this occurrence and aggressively treat postoperative hypotension. Repeat duplex ultrasonography should be obtained within three months following CAS to establish a new baseline for future comparison. Duplex surveillance is performed every six months for two years and then annually thereafter until stable (ie, no restenosis observed in two consecutive annual scans) [134]. More frequent intervals may be warranted if a contralateral stenosis is being observed. COMPLICATIONS https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 15/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Complications associated with carotid revascularization can be grouped into systemic complications that, in general, are related to the revascularization (stroke), patient comorbidities (eg, myocardial infarction [MI], chronic kidney disease), related to the stent (in-stent restenosis, stent fracture), and related to the revascularization approach. Complications specific to the approach include complications related to arterial access or related to the embolic protection system. Approach-specific complications are reviewed separately. (See "Percutaneous carotid artery stenting", section on 'Complications' and "Transcarotid artery revascularization", section on 'Complications'.) In a study that evaluated the timing of complications following CAS, 53 percent of postoperative events/complications occurred within 6 hours of CAS, 5.3 percent between 6 and 12 hours, 8 percent between 12 and 24 hours, and 34.2 percent >24 hours postprocedure [105]. Late events >24 hours were access site-related, and neurologic events included transient ischemia, minor stroke, and major stroke. Stroke The most serious acute complication associated with CAS is stroke. Periprocedural stroke related to CAS may be due to several mechanisms, alone or in combination, including the following [135]: Thromboembolism Hypoperfusion due to bradycardia and/or baroreceptor stimulation Cerebral hyperperfusion Intracerebral hemorrhage Stent thrombosis Noncompliance with antiplatelet therapy Combined 30-day stroke and death rates for transfemoral CAS (TF-CAS) in randomized trials range from 6 to 9 percent for symptomatic patients and 2 to 4 percent for asymptomatic patients [1,66,136]. Stroke rates have improved since the first introduction of CAS. The 30-day death and stroke rate was 3.6 percent in an analysis of two multicenter postmarket surveillance registries of CAS (EXACT, CAPTURE-2) that included 6320 high-risk patients [77]. A similar rate was found in later large reviews [10,79-81]. (See 'Transfemoral carotid revascularization' above.) Transcarotid artery revascularization (TCAR) appears to be associated with a lower risk for stroke compared with TF-CAS. In a study in which 3286 propensity matched pairs were studied, stroke rates were 1.3 and 2.4 percent in the TCAR and TF-CAS groups, respectively [90]. The theoretical explanation for these observations is that TCAR eliminates the need to traverse the aortic arch during the intervention where there is often considerable concomitant atherosclerotic https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 16/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate thromboembolic debris. The effectiveness of flow reversal in preventing distal embolization may also play a role. (See 'Transcarotid revascularization' above.) The main strategies used to reduce the risk of thromboembolic complications during and following CAS are appropriate patient selection, perioperative treatment with optimal medical therapy (including dual antiplatelet therapy [aspirin and clopidogrel] and statin), optimal intraoperative anticoagulation, strict postprocedural blood pressure control, and possibly choice of approach (TCAR versus TF-CAS) and choice of embolic protection. (See 'Dual antiplatelet therapy' above and 'Transcarotid revascularization' above and "Percutaneous carotid artery stenting", section on 'Embolic protection devices' and "Transcarotid artery revascularization", section on 'Establishing flow reversal and carotid stenting'.) Hyperperfusion syndrome Cerebral hyperperfusion syndrome is an uncommon sequela of CAS, and its occurrence after carotid stenting follows a similar path to that following carotid endarterectomy (CEA) [137]. The syndrome is often heralded by headache ipsilateral to the revascularized internal carotid artery. Focal motor seizures and intracerebral hemorrhage may follow. As with CEA, hypertension is a frequent predecessor of the syndrome, underscoring the importance of adequate control of perioperative blood pressure. (See 'Preoperative control of blood pressure' above and "Complications of carotid endarterectomy", section on 'Hyperperfusion syndrome'.) Scant data exist concerning the incidence of the hyperperfusion syndrome after carotid stenting. In a retrospective review of 450 patients treated with CAS, the following observations were made [138]: Hyperperfusion developed in five patients (1.1 percent), all of whom had correction of a severe internal carotid stenosis (mean 96 percent). All five patients with hyperperfusion syndrome had contralateral carotid stenosis >80 percent or occlusion, and baseline hypertension. Intracerebral hemorrhage developed in three of the five patients, two of whom developed significant periprocedural hypertension preceding the intracerebral hemorrhage. Two of the patients with intracerebral hemorrhage died. Myocardial infarction In major randomized trials, the periprocedural incidence of MI with CAS has ranged from <1 to 4 percent [4,66]. In a study comparing 3286 propensity-matched pairs of patients undergoing TCAR and TF-CAS, there was no statistically significant difference in the risk of perioperative MI (0.2 versus 0.3 percent). In the author's experience, acute coronary syndromes can be precipitated by profound bradycardia and transient hypotension associated https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 17/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate with ballooning the stent. Even with routine prophylactic strategies to avoid bradycardia, cardiac ischemia still sometimes occurs. Other risk factors for cardiac complications in noncardiac surgery and management of perioperative MI are discussed in detail elsewhere. (See "Evaluation of cardiac risk prior to noncardiac surgery" and "Perioperative myocardial infarction or injury after noncardiac surgery".) Data from the National Inpatient Sample on 1,083,688 patients who underwent CEA or CAS found that 11,341 (approximately 1 percent) developed non-ST elevation MI (NSTEMI) during hospitalization. NSTEMI was associated with a significantly higher rate of in-hospital mortality (6.2 versus 0.4 percent), neurologic complications (6 versus 1.4 percent), and longer hospital stay (12.2 versus 2.8 days) [139]. (See "Acute coronary syndrome: Terminology and classification" and "Overview of the acute management of non-ST-elevation acute coronary syndromes".) Renal dysfunction Renal dysfunction following CAS can be related to contrast-induced nephropathy, renal atheroemboli (during TF-CAS), or renal hypoperfusion due to hemodynamic instability. The risk of contrast nephropathy following CAS is greatest in patients with moderate- to-severe renal insufficiency and diabetes. (See "Contrast-associated and contrast-induced acute kidney injury: Clinical features, diagnosis, and management" and "Prevention of contrast- associated acute kidney injury related to angiography".) Instrumentation of the aorta during TF-CAS can lead to atheroembolic events, which in turn can result in renal dysfunction. (See "Clinical presentation, evaluation, and treatment of renal atheroemboli" and "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)".) Carotid thrombosis and restenosis Acute and subacute in-stent thrombosis has been reported in 0.5 to 5 percent of patients with CAS [140,141]. Some cases of carotid restenosis following CAS may be related to inadequate or discontinued antiplatelet therapy [142-144]. Beyond 30 days, early restenosis after CAS is mainly due to neointimal hyperplasia, which is related to vascular injury related to the stent regardless of the technique used to place the stent (ie, TF-CAS, TCAR) [145-147]. Neointimal hyperplasia related to CAS may be due to stent overdilation or imperfect positioning of the carotid stent in the vessel leading to ongoing vascular injury, and it may occur more often in women and in patients with poorly controlled diabetes or hyperlipidemia [148]. Prior radiation is also a risk factor. Data regarding restenosis come primarily from trials and observational studies evaluating TF-CAS. Reported rates of early restenosis after CAS vary widely [64,148-154]. In a systematic review that analyzed 34 carotid stenting studies involving 3814 arteries, angiographic restenosis, defined as 50 to 70 percent stenosis (a lower threshold), occurred in approximately 6 percent of arteries https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 18/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate after one year [149]. This compares favorably with reported rates of restenosis in the first 12 to 18 months after CEA, which range from 5.2 to 11.4 percent [150-152]. In a review of 1060 patients, independent risk factors for restenosis 70 percent identified on logistic regression included hypertension (hazard ratio [HR] 6.2, 95% CI 1.9-19.9), impaired vasoreactivity (HR 1.7, 95% CI 1.09-2.8), and angioplasty without stent (HR 2.9, 95% CI 1.2-6.8) [154]. In the SAPPHIRE trial, target vessel revascularization (TVR) was performed for a stenosis of 50 percent with ischemic neurologic symptoms or a stenosis of 80 percent without neurologic symptoms [64,155]. At one year after the procedure, the rate of TVR was significantly lower for the stenting group compared with the endarterectomy group (0.6 versus 4.3 percent) [64]. At three years postprocedure, the rate of TVR remained lower for TF-CAS compared with endarterectomy (2.4 versus 5.4 percent), but the difference was not significant [155]. In the Asymptomatic Carotid Trial I (ACT-1), the one-year rate of TVR was also lower for the stenting group (0.6 versus 2.6 percent) [62]. In a secondary analysis of the CREST trial, 2191 patients with appropriate postoperative ultrasonography were available for study (CAS 1086, CEA 1105) [148]. The rates for restenosis at two years were similar for CAS compared with CEA. Female sex, diabetes, and dyslipidemia were independent predictors of restenosis or occlusion after the two procedures. Smoking predicted an increased rate of restenosis after CEA but not after CAS. At 10-year follow-up, there was no statistically significant difference in the development of restenosis or need for revascularization between transfemoral CAS and CEA (12.2 versus 9.7 percent) [69]. A single-center case series with long-term follow-up of 221 carotid stenting procedures on 193 patients showed a restenosis rate (>50 percent on duplex scan) at 10 years was 6.8 percent [156]. [149] Stent fracture Stent fracture may be a common complication of CAS, but its clinical significance is unknown. Data regarding stent fracture come from studies evaluating TF-CAS. In a retrospective report of 48 carotid stents in 43 patients, stent fracture was detected at a mean radiologic follow-up of 18 months in 29 percent [157]. The risk of stent fracture was associated with the presence of arterial calcification in the region of the deployed stent (odds ratio 7.7, 95% CI 1.9-32.0). Restenosis >50 percent was present in 3 of the 14 fractured stents and 3 of 34 stents without fracture. In a review of the outcomes of the ACT-1 trial, in which CAS was used in 1021 standard surgical risk patients with asymptomatic carotid stenosis, stent fracture was detected in 5.4 percent of 939 patients who had at least one radiograph during follow-up [158]. There was no association between stent fracture and the occurrence of carotid restenosis or for a primary composite endpoint of stroke, death, or MI. https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 19/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate SOCIETY GUIDELINE LINKS Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Occlusive carotid, aortic, renal, mesenteric, and peripheral atherosclerotic disease".) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) Basics topics (see "Patient education: Carotid artery disease (The Basics)") SUMMARY AND RECOMMENDATIONS Carotid artery stenting (CAS) can be performed percutaneously (eg, transfemoral CAS [TF- CAS]) or through a small incision in the neck (ie, transcarotid artery revascularization [TCAR]). A comparison of these methods is provided above. During CAS, several methods of embolic protection are used and are intended to prevent stroke; however, the superiority of one method over another, and furthermore, an overall benefit has not been definitively established. (See 'Approach to carotid artery stenting' above and "Percutaneous carotid artery stenting", section on 'Embolic protection devices' and "Transcarotid artery revascularization", section on 'Transcarotid stenting system'.) For patients with severe bilateral carotid stenosis, we prefer a staged approach rather than simultaneous CAS. Simultaneous CAS theoretically increases the risk for cerebral https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 20/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate hyperperfusion syndrome, as well as severe bradycardia or hypotension related to bilateral baroreceptor irritation. (See 'Timing and other considerations' above.) For patients in whom CAS is scheduled or anticipated, we recommend pretreatment with dual antiplatelet therapy (DAPT) using aspirin and clopidogrel, rather than monotherapy or no antiplatelet therapy (Grade 1B). DAPT is continued for at least four weeks after the procedure. Aspirin alone is subsequently continued indefinitely to reduce the risk of future cardiovascular events. (See 'Dual antiplatelet therapy' above and "Prevention of cardiovascular disease events in those with established disease (secondary prevention) or at very high risk".) For patients with a history of neck irradiation, we suggested continuing DAPT using aspirin and clopidogrel indefinitely (Grade 2C). Radiated patients are at high risk for recurrent carotid stenosis following CAS (See 'Dual antiplatelet therapy' above.) Specific pre- and post-treatment DAPT dosing regimens for TF-CAS and TCAR are provided separately. Statin therapy is also recommended. (See "Percutaneous carotid artery stenting", section on 'Antiplatelet/statin therapy' and "Transcarotid artery revascularization", section on 'Dual antiplatelet therapy and statins'.) The most serious acute complication associated with carotid artery stenting (CAS) is stroke, which can occur due to thromboembolism, hypoperfusion, hyperperfusion syndrome, or hemorrhage. Potential factors that have an impact on the risk of stroke with CAS include older age, carotid plaque morphology, prior neck irradiation, and contralateral carotid occlusive disease. The main strategies used to reduce the risk of thromboembolic complications during and following CAS are appropriate patient selection, perioperative treatment with aspirin and clopidogrel (dual antiplatelet therapy), and optimal intraoperative anticoagulation. (See 'Complications' above and 'Risk assessment' above.) Other complications associated with CAS include access-related issues (eg, hematoma, bleeding, pseudoaneurysm formation, and distal atheroembolization), myocardial infarction, contrast-related renal failure, restenosis of the target lesion, and carotid stent fracture. (See 'Complications' above and "Percutaneous carotid artery stenting", section on 'Complications' and "Transcarotid artery revascularization", section on 'Complications'.) ACKNOWLEDGMENTS The UpToDate editorial staff acknowledges Emile R Mohler, III, MD (deceased), who contributed to an earlier version of this topic review. https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 21/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate The editorial staff at UpToDate also acknowledges Ronald M Fairman, who contributed to an earlier version of this topic review. Use of UpToDate is subject to the Terms of Use. REFERENCES 1. 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