Postapproval Trial On Carotid Stenting in Patients With High Risk Vs Standard Risk for Open Carotid Endarterectomy(REAL)

Inclusion Criteria: * Symptomatic patients who have a transient ischemic attack, amaurosis fugax, or minor nondisabling stroke in the distribution of the study artery within 180 days of inclusion and have been shown carotid artery stenosis ≥50% by angiography, ≥70% by ultrasound, or ≥70% by CT angiography or MR angiography if ultrasound is 50% to 69% * Asymptomatic patients who have carotid artery stenosis of ≥60% by angiography, ≥70% by ultrasound, or ≥80% by CT angiography or MR angiography if ultrasound is 50% to 69% Exclusion Criteria: * Patient is unable to respond to external questions and stimuli and to exert a pressure with the contralateral hand * Patient has an myocardial infarction within 72 hours prior to carotid stenting * Patient has a major residual neurological deficit (stroke scales: Barthel ≤ 60, NIH ≥ 15 or Rankin \>3) at pre-procedure neurological exam * Patient had a transient ischemic attack (TIA) or amaurosis fugax within 48 hours prior to index procedure * Patient had a stroke or retinal artery occlusion within 1 month prior to index procedure * Patient has severe chronic renal failure (creatinine \> 2.5mg/dL) * The target carotid artery is completely occluded * The common carotid artery ostium has stenosis that required treatment * The presence of ipsilateral intracranial stenosis that requires treatment * The inability to position a stiff 0.035" guidewire in the external carotid artery * Contralateral occlusion of internal carotid artery and vertebral arteries