Carotid stent as cerebral protector: the arrival of Godot

Filter protection in contemporary carotid artery stenting: consider limited protection

“…On the other han, the anti-embolic stent cerebral protection is exerted only after the stent full deployment and optimisation – but it then extends throughout the stent healing period. These filter limitations do not apply to proximal protection by transient flow cessation or reversal [ 5 , 7 , 9 , 15 ]…”

“…It is important to note that the anti-embolic stent will exert its cerebral embolism prevention only from the point of its implantation and full optimisation [ 5 ]. Proximal/distal protective devices and anti-embolic stents play complementary roles in cerebral protection and cannot be replaced by each other, and they are not to be used interchangeably [ 5 , 10 , 15 ].…”

“…There remains a need to take advantage of the unique features of proximal embolic protection systems (including their potential to completely prevent cerebral ischaemic events) [ 5 , 7 , 9 , 10 ], particularly when treating lesions of increased embolic risk. CAS operators should be cognisant of the fact that the anti-embolic stent cannot be expected to exert any effect until implanted and post-dilated [ 15 ]. Practical knowledge and experience on how to use proximal cerebral protection to reduce intra-procedural embolic complications of CAS is an indispensable element of today’s competent CAS [ 5 , 7 ].…”