The Latest in Carotid Artery Stenting-The Importance of Procedural Embolic Protection

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Video Summary

The discussion focuses on embolic protection during carotid artery stenting, emphasizing procedural and biologic protection to minimize stroke risk from microembolization, especially post-stent ballooning. Various devices are reviewed, including distal filters like the Paladin balloon filter with smaller pore sizes (40 microns) that reduce microemboli comparably to TCAR and endarterectomy. Proximal protection strategies, such as the MOMA device and TCAR, are favored for complex cases with tortuous arteries or severe calcification, as they protect the entire procedure but have limitations like larger sheath size and patient tolerance. The use of intravascular lithotripsy (IVL) is explored cautiously for heavily calcified lesions, with experts recommending endarterectomy first unless not feasible. While IVL shows promise in improving stent expansion and reducing complications, concerns remain about manipulation increasing stroke risk. Overall, embolic protection is deemed mandatory in carotid stenting, with device choice tailored to patient anatomy and risk, aiming to minimize embolic volume and improve safety outcomes.

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Peter Soukas, MD, FSCAI

Keywords

carotid artery stenting

embolic protection

distal filters

proximal protection

intravascular lithotripsy