Embolic Protection Devices in Carotid Artery Stenting: Indications, Technique, and Efficacy Overview

Introduction: Carotid artery angioplasty and stenting (CAS) is a well-established intervention for carotid revascularization. Despite the risk of cerebral atheroembolization during neurointervention, unprotected CAS is not uncommon and has equivocal efficacy in comparison to protected CAS.

Method(s): The two main strategies of EPDs are use of temporary filter or flow occlusion (using balloons) with or without flow reversal. These can be placed proximal or distal to the lesion. The most employed method is the use of a distal filter to “catch” the emboli/atherosclerotic debris dislodged during manipulation of the atherosclerotic plaque, with preserved antegrade flow. Table 1 describes common EPDs in CAS with their mechanisms of action, technique, associated complications and clinical trials.

Result(s): Risk of cerebral embolization is ubiquitous across all neurointervention, pre- and postprocedure. However, recurrence of stroke during CAS may have disabling effects on patients who could undergo near-complete recovery post-CAS and will need mechanical/aspiration thrombectomy/complex intervention.

Conclusion(s): EPD use is advantageous but might add to the complexity and duration of the procedure and cost to the patient. Hence, EPD use must be decided on case-to-case basis.

Publication History

Article published online:
09 February 2023