title: New technologies for CAS that might overcome the burden of microembolization.
abstract: Microembolization during carotid artery stenting (CAS) is the result of embolic events shown by intraprocedural transcranial Doppler (TCD) or postprocedure diffusion-weighted MRI that do not lead to acute neurological deficit. Although the long term clinical outcome of these silent infarcts is not yet well established, there is increasing evidence that these events could be associated with neurological impairments, such as cognitive decline. In order to prevent microembolization due to excessive catheter manipulation at the time of guiding catheter placement in patients with challenging anatomy, a cervical access system with flow reversal protection was developed. Other embolic events are often seen as the result of plaque protrusion through stent struts. A new type of stent, so-called "hybrid" stent, incorporates the flexibility and conformability of an open-cell stent as well as plaque coverage seen with a close-cell stent, with the goal of achieving better plaque stabilization reducing macro and microembolization, while maintaining original vessel anatomy and flow hemodynamic. At the present time there are three different stents under investigation or this application.
authors.affiliation: Medical University of South Carolina, MUSC, Charleston, SC, USA - schonhol@musc.edu.
authors.forename: R
authors.initials: R
authors.lastname: Yamada
authors.forename: M
authors.initials: M
authors.lastname: Guimaraes
authors.forename: J
authors.initials: J
authors.lastname: Adams
authors.forename: C
authors.initials: C
authors.lastname: Schönholz
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D057505:Embolic Protection Devices; D006439:Hemodynamics; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices