Book chapter
Embolic Protection Devices for Carotid Artery Stenting: Where Is the Evidence?
Advanced Technologies in Vascular Neurosurgery, pp 71-86
18 Mar 2025
Abstract
Carotid artery disease (CAD) remains a common clinical entity that can lead to stroke. Several clinical trials now show sufficient evidence that carotid artery interventions, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can reduce the risk of stroke and stroke-related deaths. Major trials have shown noninferiority of CAS over CEA when using composite end points of myocardial infarction, stroke, and death. However, despite two decades of evolution, CAS has failed to be adopted as a superior alternative to CEA due to increased periprocedural stroke rates. CEA remains the standard of care in the treatment of cases not deemed high risk due to its ability to achieve flow arrest that prevents distal embolization of plaque particles from plaque disruption. The technical innovations in CAS resulted in the development of a wide array of proximal and distal embolic protection devices (EPDs) designed to reduce the periprocedural stroke risk and make CAS and CEA equivalent across all time points. Although data regarding their effectiveness are controversial, and there is a lack of randomized controlled trials (RCTs) supporting the superiority of protected over unprotected CAS, EPDs have become the standard of care in CAS.
This chapter sheds light on the results from the most recent prospective multicenter trials supporting the presumption that EPDs do not reduce but may increase CAS complication rates. We also describe the newer protection technique “transcarotid artery revascularization (TCAR).” This is a hybrid procedure that combines the minimally invasive advantages of CAS while also using complete carotid artery blood flow reversal as neuroprotection.
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Details
- Title
- Embolic Protection Devices for Carotid Artery Stenting: Where Is the Evidence?
- Creators
- Mohanad SulaimanMandy J. Binning
- Contributors
- Erol Veznedaroglu (Editor)
- Publication Details
- Advanced Technologies in Vascular Neurosurgery, pp 71-86
- Publisher
- Springer Nature Switzerland; Cham
- Resource Type
- Book chapter
- Language
- English
- Academic Unit
- Neurology; Neurosurgery
- Scopus ID
- 2-s2.0-105005383839
- Other Identifier
- 991022041725804721