Today, carotid artery stenting is an accepted less-invasive alternative to surgical endarterectomy for carefully selected patients, particularly those at significant surgical risk, and market projections are very positive. But, the field still has a long way to go before this procedure is considered routine.

While the greater efficacy of drug-eluting stents (DES) compared to bare-metal stents is widely accepted, over the past year, data has continued to build showing that first-generation DES also have a higher late-stage in-stent thrombosis risk, a complication that can cause death 30% of the time, according to some estimates. The findings of these studies had some physicians at this year's World Congress of Cardiology calling for "an immediate halt to DES overuse." However, most conceded that additional randomized trials will be needed to fully understand the potential risks associated with these devices.

Just as drug-eluting stents prevent heart attacks by maintaining the patency of coronary arteries, so do carotid artery stents prevent strokes by keeping carotid arteries open. Carotid artery stenting, like coronary stenting, is a minimally invasive, percutaneous procedure and both procedures use similar kinds of devices. The large cardiovascular device companies are all in clinical trials with carotid artery stents, but none is expected on the US market before 2005. Still, the market for carotids isn't likely to be nearly as big as that of coronary stents.