"Seat belt and air bag" technique for cerebral protection during carotid stenting.
OBJECTIVE
To present a 2-device technique for cerebral protection during carotid stenting of the internal carotid artery (ICA) in patients with high-grade lesions, contralateral occlusion, and/or an aberrant or nonfunctioning circle of Willis.


METHODS
A reverse flow system (Parodi Anti-Embolism System [PAES]) is first placed with a 260-cm exchange wire in the common carotid artery 3 cm below the carotid bifurcation. Flow reversal is obtained by inflating the balloons in the external and common carotid arteries. Via an external connector, a guidewire and E-Trap filter are delivered to the distal ICA with active suction from a syringe on the PAES catheter. Once the filter is above the stenosis, the reversed flow is discontinued, and the procedure proceeds under cerebral protection with the filter.


CONCLUSIONS
The combination of 2 existing cerebral protection devices could, at least in theory, achieve what neither of them could independently. The "seat belt and air bag" approach may represent the ideal means of treating ICA stenoses in patients with a non-functioning circle of Willis.
Parodi
Juan C
JC
Department of Vascular Surgery, Instituto Cardiovascular de Buenos Aires, Argentina.
Schönholz
Claudio
C
Ferreira
L Mariano
LM
Mendaro
Esteban
E
Ohki
Takao
T
D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000628:therapy*; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011322:Primary Prevention / Q000295:instrumentation / Q000379:methods; D012680:Sensitivity and Specificity; D015607:Stents; D014654:Vascular Patency