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Carotid stent trials: past, present, and future.

Carotid stenting has emerged as a therapeutic alternative to standard carotid endarterectomy in patients with carotid bifurcation disease. The percutaneous modality holds the potential to replace a large proportion of the carotid surgical procedures performed throughout the world. Carotid stenting has undergone technologic advances in the last decade, including improved sheaths and guides, lower profile balloons and stents, and the almost ubiquitous use of dependable distal embolization protection devices. Contemporary data confirm the safety and efficacy of the procedure for patients with high-grade lesions who are at higher-than-normal risk for standard open carotid repair. Whether lower-risk patients should be offered stenting as an alternative to carotid endarterectomy is a question that must await the results of ongoing clinical trials.