Endovascular prevention and treatment of stroke related to extracranial carotid artery disease.

Acute ischemic stroke (AIS) is the leading cause of premature mortality and morbidity worldwide for both men and women. Extracranial carotid artery stenosis/occlusion is responsible for approximately 11.5% of ischemic strokes, whereas extracranial large vessel disease comprises roughly 16.6% of ischemic strokes. Carotid artery disease has been the source of significant debate among neurovascular and cardiovascular specialists, as well as vascular surgeons, as to the best method of revascularization, surgical reconstruction versus endovascular recanalization. There are different treatment modalities and techniques related to AIS and extracranial carotid artery disease based on the different etiologies, and these include acute internal carotid artery occlusion (thrombectomy versus carotid stenting/angioplasty), tandem occlusions (stenting and thrombectomy), and non-emergent carotid stenting/angioplasty for chronic internal carotid artery stenosis. The continuing development of new endovascular technology has led to a major shift in treatment to a minimally invasive endovascular approach. Distal filter devices, proximal protection devices, balloon-guided catheters, open- or closed-cell stents, and flow-reversal stenting are some of the technologies that are now available. The latest treatment techniques, indications, and studies are discussed in this review.