update on percutaneous management of carotid bifurcation disease

1. Abstract Carotid artery revascularization has shown better outcomes for carotid artery disease management when compared to medical therapy alone, particularly for symptomatic patients.  However, we still debate whether revascularization is beneficial for asymptomatic patients in the setting of contemporary medical therapy.  The mode of revascularization Carotid Artery Stenting (CAS) or Carotid Endarterectomy (CEA) has also been debated. Earlier trials showed favorable outcomes for CEA versus CAS, but more recent data with contemporary devices and more operator experience suggest equivalent outcomes. Though some clinical guidelines for the prevention of stroke concluded  equipoise for CAS  and CEA, the Centers for Medicare and Medicaid Services (CMS) only reimburse CAS for symptomatic patients at a higher  risk  for surgical complications, thereby limiting its usage. Whether symptomatic or asymptomatic, a patient-centered approach should consider medical management, CAS and CEA as complementary to each other. 2. Keywords:  Carotid Artery Disease; Carotid Artery Stenting; Carotid Endarterectomy; Carotid Revascularization; Extracranial Carotid Disease