Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients

Carotid Artery Stenting: Second Consensus Document of the ICCS/ISO-SPREAD Joint Committee

“…Cerebral protection and relevant devices, the type of stenting, and the ultrasonography/imaging profile of the stenosis and plaque are all issues deserving adequate discussion, although until now no positions, except those on cerebral protection, are sufficiently supported by the evidence. On this point, current evidence supports the notion that stenting procedures are less prone to periprocedural risks when adequate cerebral protection is applied with a device the interventionist is familiar with and is an expert trained well in its use[46,47,48,49,50,51]. However, this statement is supported essentially by case series, some of which are quite large but probably not bias free [52].…”

Carotid artery stenting: findings based on 8 years’ experience

“…Many recent nonrandomised studies have shown that CAS combined with cerebral protection is a safe and effective treatment of carotid artery stenosis [21,[29][30][31][32][33][34]. Even indications for CAS have broadened over the years.…”

“…Dai principali trials randomizzati che mettono a confronto la tecnica chirurgica con la tecnica endovascolare è emerso infatti che, mentre nel CAVATAS e SAPPHIRE sulla base delle complicanze peri-procedurali, l'incidenza di stroke e morte è comparabile nelle due tecniche [24][25][26] con un rapporto rischio/beneficio maggiore in pazienti ad alto rischio chirurgico [25,26], nell'EVA-3S e SPACE il tasso di complicanze risulta molto più elevato nel CAS rispetto alla TEA [27][28][29][30][31][32][33][34][35][36][37][38] …”

“…Whereas the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) report a comparable incidence of stroke and death between the two techniques [24][25][26], with a better risk/benefit ratio in high-surgical-risk patients [25,26], EVA-3S and SPACE report a higher number of complications in CAS than in CEA [27][28][29][30][31][32][33][34][35][36][37][38]. In contrast to these findings, a number of single-centre studies have demonstrated a decrease in the incidence of complications thanks to the development of increasingly high-performance systems and increased operator experience.…”

Safety and efficacy of endovascular treatment for carotid artery stenoses using proximal protection systems: 30-day follow-up

“…Other researchers found that complications were associated with bilateral carotid disease, long lesions, advanced patient's age and a history of myocardial infarction [10,11,[13][14][15][16]. Data revealed by large-scale registries on endovascular carotid interventions suggest that because of a risk of cerebral embolisation, the use of protection system during CAS is warranted [10,11,17,18]. Indeed, in our patients very often there was quite a lot of embolic material filtered by protection system (Table 4).…”