Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are currently the most commonly used and effective treatment methods for carotid atherosclerotic stenosis. However, because of differences in operative performance, applicable population and perioperative complications between the two procedures, there has been continued controversy over the selection of treatment method. In this paper, the authors review the developmental history of this issue and summarize the results of the related controlled clinical trials.

With the development and application of advanced materials and new techniques in recent years, encouraging achievements have been made in endovascular therapy of arteriosclerosis obliterans of the lower extremities. In this paper, the author summarizes the advances from recent related controlled clinical trials, and suggests the existing problems and future prospects.

In endovascular therapy of lower-extremity arteriosclerosis obliterans, attention has been focused on the proper management of the lesions involving the popliteal artery. In this paper, the author discussed the technical essentials of endovascular treatment for popliteal arteriosclerotic lesions from aspects of the anatomical features of the popliteal artery, choice of treatment method, whether stent placement is required and stent selection. It is pointed out that avoidance of stent implantation in the popliteal segment should be considered as the overriding principle; for those cases where stent treatment must inevitably be performed, the essential strategy for improving long-term efficacy is based on the appropriate selection of stent and a suitable stent implantation strategy, and lessening the alterations of the initial morphological pattern and hemodynamics of the popliteal artery after stent implantation.

Application of endovascular techniques has become increasingly common in treatment of arteriosclerotic lesions of the lower limbs. Their indications have gradually expanded and some "forbidden zones" considered previously are also successively explored. In this paper, the authors summarize and discuss the current indications, new explorations and methods as well as efficacy of endovascular techniques in treatment of lower-extremity arteriosclerotic lesions.

Objective: To investigate the safety and efficacy of Silverhawk atherectomy and adjunctive angioplasty in treatment of severe arterial atherosclerotic occlusive lesion below the knee. Methods: The clinical and follow-up data of 9 patients with this condition treated over the past 2 years were retrospectively analyzed. Of the patients, 3 cases were male and 6 were female, with a mean age of (64.0±9.1) years and mean disease course of (28.9±25.9) months; 5 cases had intermittent claudication, one case had rest pain, one case had toe ulcer, and 2 cases had toe gangrene; the occlusive lesion in 6 cases was located in the tibioperoneal trunk, in one case in the anterior tibial artery, and in 2 cases in the posterior tibial artery; one case underwent plaque excision alone and the other 8 cases underwent simultaneous endovascular procedure for the inflow arterial lesion. Results: All operations were successfully performed, and the recanalized artery was patent in all patients at discharge. The claudication distance increased to more than 500 m in the 5 claudication patients and the case with rest pain was relieved; the wound size of the one case with toe ulcer was reduced, and the gangrene in the 2 patients became dry and was not infected. Postoperative ankle brachial index (ABI) was increased in all patients compared with their preoperative value. All patients were followed-up for an average of (24.0±9.5) months. One patient died 23 months after operation due to myocardial infarction; claudication distance in one patient was decreased compared with the former best postoperative distance, but was still longer than the preoperative distance; the wound was healed in the ulcer patient; the rest pain that was present in one patient was relieved; of the 2 patients with toe gangrene, the dry state was kept in one case and in another case, the two gangrenous toes spontaneously detached and the wounds were healed. Conclusion: Silverhawk atherectomy and adjunctive angioplasty is a safe and effective method in treatment of severe arterial atherosclerotic occlusive disease below the knee, whereas, whether it will become a conventional treatment modality requires the verification by long-term results from randomized controlled trials.