REVIEW  PROXIMAL PROTECTION IN CAROTID ARTERY STENTING: WHO’S AFRAID OF IT? Free access

Minerva Cardiology and Angiology 2022 December;70(6):727-37

DOI: 10.23736/S2724-5683.22.06233-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Proximal versus distal protection: dissecting clinical trials

Vincenzo FIORETTI ¹, Donato GERARDI ¹, Giampaolo LUZI ², Eugenio STABILE ¹ ✉

¹ Division of Cardiology, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy; ² Division of Cardiac Surgery, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy

Carotid artery stenting (CAS) is a valid alternative to conventional carotid endarterectomy for treatment of carotid artery stenosis. Distal embolization of atherosclerotic debris causing cerebrovascular accidents during CAS has been the most significant concern limiting widespread application of CAS technology. A variety of embolic protection devices (EPDs) with different mechanism of action, have been designed to minimize the risk of major embolization causing stroke and their use is recommended by current guidelines. Two general types of EPDs are available: proximal protection devices (PPDs) and distal protection devices (DPDs). However, there is no convincing clinical evidence of the clinical superiority of one device over another. This review will examine the different types of available devices and also innovative devices and techniques, including strengths and weaknesses of each, and present the available evidence and rationale for their routine use during CAS.

KEY WORDS: Carotid stenosis; Embolic protection devices; Stroke