ABSTRACT
While enthusiasm continues to grow for carotid angioplasty and stenting (CAS) as an alternative to carotid endarterectomy (CEA), its “Achilles heel” remains the risk of distal embolization during the procedure, especially for de novo atherosclerotic lesions, where the potential for embolization of atheromatous material is substantial. The most basic of devices, balloon-occlusion devices, simply cease flow in the internal carotid artery during the period of angioplasty and stenting. Angioplasty balloons, catheters, and stents can then be loaded onto the wire and removed while the balloon occludes the internal carotid artery. Patients with early restenosis following CEA, which is most frequently myointimal in nature and carries a lower risk of embolization, may safely be treated without a protection device. At the present time, however, most would agree that embolic protection is the standard of care for the majority of patients undergoing CAS.
