While historically endarterectomy has been the treatment for carotid stenosis, stenting is an alternative intervention for patients who are not candidates for surgery.

High risk factors for endarterectomy, which would favor stenting instead, include medical comorbidities (severe heart disease, heart failure, severe lung disease) and anatomic features (contralateral carotid occlusion, radiation therapy to the neck, prior ipsilateral carotid artery surgery, intra-thoracic or intracranial carotid disease) that would make surgery difficult and risky.

Wire and sheath are advanced through the aorta to the common carotid artery on the side to be treated.

Wire access is obtained at that location and used to deliver the stent to the internal carotid artery.

Cerebral protection is usually obtained by flow reversal - the common carotid artery is clamped, and arterial blood from the internal carotid is run through a filter and returned to a femoral vein during the highest risk portions of the procedure.

Patients must still be carefully selected for surgery or stenting in order to reduce the risks related to the procedure and ensure the long-term benefit after such intervention.

Other short-term complications might include bleeding, infection and heart problems such as myocardial infarction related to anesthesia.

Late complications such as recurrent stenosis may occur, and surveillance with duplex ultrasound or CT-Angiography may be performed.