Patient selection for carotid interventions: Anatomical and comorbid factors

The purpose of this chapter is to provide guidelines for selecting patients best suited to carotid angioplasty and stent placement. Optimal patient selection remains paramount to a beneficial outcome during carotid intervention by endovascular methods, as it may be the best means of preventing complications in the first place. Meticulous technique and attention to detail are deserved for all endoluminal interventions, but for carotid intervention particularly, breaches in technique or pushing the “anatomical envelope” risks neurological disaster. While the technical challenges may be commensurate with those of other vessels, the unforgiving nature of the brain compared to other end organs mandates a choreographed procedure meticulously performed. Although endoluminal rescue procedures to ameliorate neurological sequelae from a carotid intervention can be employed, these options are extremely limited and outcomes less reliable when compared to those available to correct endovascular complications in the peripheral vascular tree.