Carotid stenting with and without protection devices: should protection be used in all patients?
Embolic events that result in neurological deficits have been the most significant concern regarding carotid bifurcation stenting. Ex vivo carotid angioplasty studies using human carotid plaques have shown that embolic particles were released from all specimens. In addition, transcranial Doppler studies have confirmed the presence of multiple emboli in the middle cerebral artery during carotid stenting. Preliminary experience with the use of brain protection devices for carotid stenting have shown encouraging results in terms of safety and efficacy. Moreover, embolic particles have been recovered from all cases in which protection devices have been used. We provide the rationale for routine use of these protection devices and also review the various protection devices on the horizon.
Ohki
T
T
Department of Surgery, Montefiore Medical Center, and Albert Einstein College of Medicine, New York, NY, USA.
Veith
F J
FJ
D016893:Carotid Stenosis / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents