Data from randomized controlled trials (RCTs) demonstrated significant differences between carotid artery stenting (CAS) and
carotid endarterectomy (CEA) in terms of early neurological outcomes (from 0 to 30 days), although mid- and long-term neurological results are indistinguishable. CAS in symptomatic standard risk patients is coupled with a higher risk of any
stroke, and death or any
stroke at 30 days, while the rates of disabling or major
stroke do not vary remarkably between treatments. Since the micro-embolization through the
stent struts is the primary suspected cause of suspected early postoperative neurological complications (i.e., non-disabling
stroke), surgical technology has focused on the production of a new generation of
stents with a double layer of mesh to reduce the "free area" of the cells, and on new cerebral protection devices. Another major determinant of early negative outcomes is believed to be the intraluminal manipulation occurring during carotid engagement from the aortic arch, the crossing maneuvers at the level of the culprit lesion and vessel
trauma during angioplasty. To address these subject matters, new
embolic protection devices and innovative strategies have been developed, consequently. This review is designed to furnish the current status of CAS results, to update the ongoing RCTs comparing CAS vs. CEA outcomes, and to recapitulate the features and clinical outcomes for a new carotid
stent design, the so called "mesh-
stents", and new embolic protection tools.