Impact of Cerebral Protection Devices on Early Outcome of Carotid Stenting

Abstract

Our data suggest that percutaneous dilation and stenting of the carotid arteries protected by cerebral protection devices is feasible and effective. In a consecutive series, the use of the cerebral protection systems reduced the acute neurological event rate related to embolic complications by 79%.

Carotid Stenting without Use of Balloon Angioplasty and Distal Protection Devices: Preliminary Experience in 100 Cases

“…1,[17][18][19] Because of this relatively high incidence of adverse effects, efforts have been made to reduce their incidence by using CPDs during CAS. 4,5,20,21 An extensive literature review indicates that the use of CPD can decrease the incidence of 30-day combined stroke and death rate after CAS from 5.5% without the use of CPD to 1.8% with CPD. 4 Wholey et al, 22 on the global carotid artery stent registry, reported a reduction in stroke rate and procedure-related death from 5.29% in patients without protection to a 2.23% rate when using protection.…”

“…[1][2][3] Nevertheless, one of the limitations of CAS is the potential for embolic stroke caused by plaque dislodgement of atheromatous material. 4,5 To prevent it, a variety of cerebral protection devices (CPDs) have been developed in the last years. Preliminary results have shown that these devices can significantly reduce thromboembolic complication during CAS.…”

“…Preliminary results have shown that these devices can significantly reduce thromboembolic complication during CAS. 4,5 However, concerns have been raised regarding these protection devices, because they add further manipulation, cost, and risk to the procedure. 6,7 It has been suggested that reducing the number of endovascular maneuvers in the supra-aortic vasculature can decrease the risk of plaque material dislodgment.…”

Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years' Follow-Up

“…In the past years, with the advent of CPDs, thromboembolic complications were significantly reduced. 7,8 Nevertheless, their clinical efficacy and safety are still a matter of controversy because they increase the risk of arterial vasospasm, thrombosis, and dissection. 9,10 Moreover, embolic signals have been observed by TCD during all phases of the carotid stent procedure, whereas in a recent study, more signals were detected with the use of filter devices.…”

Intravascular Ultrasound: Principles and Cerebrovascular Applications

“…118,136 Ruptured plaque or thrombus identified with in-travascular sonography after stent evaluation may modify the decision to use intravenous heparin or glycoprotein IIB/IIIA inhibitors before the removal of the distal embolic protection device, ultimately reducing poststent embolic events. 13,118,[137][138][139][140][141][142][143] Intravascular sonography can also be potentially used during the treatment of an acute ischemic stroke to help identify the exact composition of the obstructing lesion-calcified versus fibrous versus soft clot. A more aggressive mechanical disruption/ retrieval strategy may be advocated in the presence of calcific or fibrotic occlusion.…”