Safety and feasibility of a novel transcervical access neuroprotection system for carotid artery stenting in the PROOF Study

Abstract

In this first-in-man experience, FAST-CAS using the MICHI Neuroprotection System was shown to be a safe and feasible method for carotid revascularization. DW-MRI findings suggest controlled reverse flow provides cerebral embolic protection similar to that seen with CEA.

Prospective comparison of cognitive effects of carotid endarterectomy versus carotid stenting with flow reversal or distal filters

“…The blood flow is reversed in the treated carotid as a protective measure to ensure that emboli flow away instead of towards the brain (Pinter et al, 2011). CASfr gained a lot of attention because manipulation in the aortic arch and common carotid artery is avoided and because of a reduced number of new diffusion-weighted magnetic resonance imaging lesions caused by emboli showers typically observed during stenting and dilation using distal embolic protection (Pinter et al, 2011).…”

Commentary: Carotid Artery Revascularization for Stroke Prevention

“…Technological advancements, including mesh-covered carotid stents for sustained embolic prevention, 11,13,62,64,65,72 taken together with optimized use of temporary protection (with a focus on proximal protection systems for high-risk lesion subsets in particular 11,53,54,56,57,60,66 ) and increased endovascular operator experience 70 may ultimately make CAS a safer procedure that CEA. 35 …”

“…48 Today, DW-MRI is an important tool in evaluating minimization of intraprocedural embolization with improved temporary neuroprotection systems. 56.57,59 DW-MRI is similarly fundamental in evaluating the efficacy of different stent designs in reducing periprocedural and delayed cerebral embolism. 68 With routine DW-MRI use, the CGuard EPS system was associated with >50% reduction in the incidence of periprocedural DW-MRI lesions and a >10-fold reduction in average lesion volume.…”

A Case of Tumor Embolization for Metastatic Bone Tumor and Stanford Type A Aortic Dissection under Direct Carotid Puncture

“…It is a safe and useful technique by which consistent hemostasis is possible regardless of the thickness of the sheath used or whether or not heparin is used. 6,[11][12][13][14][15][16][17][18][19] Demerits of the technique are complications associated with general anesthesia and prolongation of the surgical time. However, the merit of avoidance of the risk of puncture troubles and postoperative hematoma formation is significant, warranting the preparation of an environment capable of handling cervical incision under general anesthesia.…”