At the 31st Charing Cross International Congress of Vascular Surgery, hosted by the Royal College of London in early April 2009, Professor Wilhelm Sandmann from Germany noted that carotid endarterectomy has good durability, good intermediate and long-term outcomes, and low restenosis rates – especially with exenteration endarterectomy and patchplasty. Also the rate of unilateral cerebral infarction as well as recurrence of cerebral infarction is low. These outcomes are lacking in stenting. The current high rate of restenosis after carotid stenting has become increasingly evident, along with stent migration, kinking, collapse, and dissection. Higher rates of cerebral infarction, mortality, restenosis and intracranial hemorrhage have been reported outside of clinical studies with carotid stenting. Professor Wilhelm Sandmann considers carotid stenting to be like a fine and fast ship. The boat can sail calmly and quickly, but only in sunny weather, smooth water and mild winds; it is also very expensive, has limited durability, and requires constant maintenance.