Impact of Aspiration Thrombectomy During Carotid Stenting

Inclusion Criteria: * ICA stenosis greater than 50 percent by carotid angiography * Documented hemispheric ischemic stroke, TIA, amaurosis fugax, or retinal stroke in the last six months ipsilateral to the stented lesion Exclusion Criteria: * Subject less than 40 years of age * Pregnant subjects * Asymptomatic carotid stenosis * Total occlusion of target carotid artery * Inability to deploy distal protection device or stent in target vessel * Allergy to both aspirin and approved thienopyridine anti-platelet drugs (clopidogrel/ticlopidine) * Multiple carotid stenoses in same vessel that cannot be covered by single stent * Ipsilateral intracranial stenosis requiring treatment * Isolated common carotid stenosis * Stenosis less than 50 percent by angiography * Chronic or paroxysmal atrial fibrillation not treated with warfarin or dabigatran. * Life expectancy less than 30 days * Active bleeding diathesis * Suspected Myocardial Infarction within 72 hours prior to carotid stenting * Presence of intracranial tumor arteriovenous malformations or aneurysm requiring treatment * Inability to undergo DWMRI * Unwillingness to participate or provide consent * Subjects using a legally authorized representative for consent for participation * Concurrently enrolled in another study * Stroke, TIA, amaurosis fugax ipsilateral to the treated lesion more than 6 months from randomization * Occlusive or critical ilio-femoral disease that precludes safe femoral access to the aortic arch * Severe atherosclerosis of the aortic arch or origin of the innominate or common carotid arteries * Prior large stroke, multiple lacunar infarcts, or dementia * Stenosis that contain visible thrombus