Carotid artery stenting performed with a flow-reversal technique: Improved technical performance

Flow Reversal Versus Filter Protection

“…performed 450 CAS procedures, of which 412 cases using filter devices, 27 cases using proximal protection devices with flow arrest, and 12 cases using proximal protection with flow-reversal before the start of the randomization. 18 Although the operator experience was lower with the new GORE device, and this may be seen as a limitation of our study, the EMPiRE study showed a low major adverse cardiac and cerebrovascular event rate (1.8%) in the 56 roll-in patients (2 roll-in cases per institution), which suggested that experienced interventionalists can learn to use the GORE flow-reversal system quickly and obtain good results. 44 Moreover, we tested the influence of the learning curve on primary end points.…”

“…The technique protocol has already been published. 18 All CAS procedures using filter protection were performed according to previous carotid interventions report. 19 All devices were placed on the procedure table before puncturing and consisted of a distal filter wire EZ (Boston Scientific), a 7F sheath (Arrow International, Berneville road, PA), a vertebral 5F catheter or Simons 5F catheter as appropriated (Meritmedical Systems Inc, South Jordan, UT), a 7Fr guiding catheter (Guider Softip; Boston Scientific, Natick, MA), a hydrophilic guide wire (Angiotech, Gainesville, FL), a 2.5 or 3.0×20 mm Monorail predilatation balloon (Boston Scientific, Maple Grove, MN), a 0.014-in×182-cm J-Tip, Floppy Choice guide wire (Boston Scientific, Miami, FL), a 5.5 or 6.0×20 mm, 153 cm, Monorail postdilatation balloon (Boston Scientific, Maple Grove, MN), and a close cell stent Wallstent (Boston Scientific, Natick, MA).…”

Cerebral Protection in Carotid Angioplasty – Is There a Need? Advantages and Disadvantages of Each Type of Protection Device

“…All interventional procedures performed in craniofacial vascular regions carry an inherent risk of causing embolisms to the brain with different levels of severity. In these cases, the diffusion MRI technique is the most efficient tool for detecting acute focal cerebral ischemia [46,71,72].…”

“…Similarly, a small study (seven patients) from Schlüter et al [86] identified reversal on imaging in 76% (5/21) of the NF after CAS at an average MRI follow-up four months later. A recent study showed that 92.1% of the signs of microemboli disappeared and that 5.2% remained in an MRI study three months after the CAS [72]. Thus, the NF after CAS are potentially reversible on imaging and without neurological developments [60,75,86].…”

“…In addition to maintaining a constant flow to the brain in all phases of CAS, cerebral protection with a filter is likely to be used in all cases (unlike the occlusive balloon technique, which is reserved for patients who are candidates for temporary carotid occlusion) [42]. Other limitations of techniques that use balloon for cerebral protection include severe tortuosity of the cervical and thoracic arteries and increased diameter of the external carotid >6 mm [72]. These were our reasons for choosing filters as a means of protection in our cases.…”