Carotid stenting with embolic protection: evolutionary advances

Abstract

Stroke is one of the most significant causes of death and morbidity worldwide. Atherosclerotic stenosis of the extracranial internal carotid artery has been invoked as a common causative factor for stroke in over 20% of patients. Although medical therapy can help to prevent the onset and progression of carotid arteriosclerosis, open surgical carotid endarterectomy has been the gold standard for treating severe blockage. Carotid artery stenting has recently demonstrated efficacy in stroke prevention from atherosclerosis, and in high-risk surgical subgroups, has been shown to be associated with a reduction in the risk of myocardial infarction. The controversy for carotid stenting surrounds the incidence of periprocedural stroke. Will embolic protection devices (EPDs) decrease this risk? EPDs continue to evolve with various engineering strategies directed at increasing the efficiency of protection. There are two major categories of EPDs: distal occlusion, either with balloons (e.g., Percusurge, Medtronic Corporation, MN, USA); or distal filtration (e.g., Angioguard^®, Cordis Corporation, NJ, USA). The second method is proximal protection (e.g., MoMA device, Invatec Corporation, Brescia, Italy). We review the results of trials currently evaluating carotid stenting with both distal and proximal embolic protection.

Keywords::

• angioplasty
• carotid
• embolic
• filter
• protection
• stent
• stroke

Financial & competing interests disclosure

Gary Ansel is a Consultant for Biocardia and Possis Medical Inc.; a stockholder for ICON Interventional Systems Inc., Access Closure, Omnisonics and SimSuite and an Independant Consultant for Invatec and ev3. He also has ownership of Vascular Performance Products. Ansel is also on the advisory board for Atheromed, Bacchus Inc., BARD Inc., Boston Scientific, Cordis Johnson & Johnson, Edwards Lifesciences, Lumen Biomedical, Medical Simulation, MEDRAD, Medtronic, Nellix Inc., Omnisonics, Ostial Solutions, Paragon IP, Pathway Medical Inc., Spectranetics, Square One, Wild Crest LLC, and WL Gore; and is a salaried board member of VIVA Physicians Inc. Ansel also carries out research for Abbott/Guidant Vascular, Boston Scientific, Cook Inc., Edwards Lifesciences, Invatec, and WL Gore. He is also on the speakers bureau for Abbott/Guidant Vascular and WL Gore and is a speaker for Cordis Johnson & Johnson. Ansel also has meeting sponsorship with VIVA (www.vivapvd.com). Michael Jaff is a Consultant for Abbot Vascular and Paragon IP; and also provides research support for Abbott Vascular. Jaff also has involvement with VIVA Physicians Inc., a not-for-profit organization. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.