Stroke remains a significant risk of carotid revascularization for atherosclerotic disease. Emboli generated at the time of treatment either using endarterectomy or stent-angioplasty may progress with blood flow and lodge in brain arteries. Recently, the use of protection devices to trap emboli created at the time of revascularization has helped to establish a role for stent-supported angioplasty compared with endarterectomy. Several devices have been developed to reduce or detect emboli that may be dislodged during carotid artery stenting (CAS) to treat carotid artery stenosis. A significant challenge in assessing the efficacy of these devices is precisely determining when emboli are dislodged in real-time. To address this challenge, we devised a method of simultaneously recording fluoroscopic images, transcranial Doppler (TCD) data, vital signs, and digital video of the patient/physician. This method permits accurate causative analysis and allows procedural events to be precisely correlated to embolic events in real-time.
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