Editorial Comment—Carotid Artery Stenting With or Without Protection Devices? Strong Opinions, Poor Evidence!

Background and Purpose-Periprocedural embolization of debris during carotid stenting interventions may result inneurological deficit.This study was designed to evaluate in-hospital and 30-day adverse events in patients percutaneously treated for carotid artery disease with embolic protection devices.Methods-From 1999 to June 2002, a total of 442 consecutive patients underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery.The endovascular procedure was conducted under embolic protection devices.Results-The percutaneous procedure was successful in 440 of 442 patients (99.5%).No periprocedural death occurred with any embolic protection device.All in-hospital stroke/death and 30-day ipsilateral stroke/death rate was 1.1%.The overall complication rate was 3.4%.Major adverse events included 1 major stroke (0.2%), 4 intracranial hemorrhages (0.9%), 1 carotid artery wall fissuration (0.2%), and 1 diffuse cardioembolism (0.2%).Minor adverse events included 4 minor strokes (0.9%) and 4 transient ischemic attacks (0.9%).The cerebral protection device-related complications were 4 (0.9%): 1 case of abrupt closure of the internal carotid artery because of spiral dissection (0.2%), 1 case of trapped guide wire (0.2%), and 2 cases of intimal dissection (0.5%).Transient loss of consciousness, tremors, and fasciculations were present in 6 of 40 patients (15%) in whom occlusive protection devices were used.Conclusions-Our data suggest that percutaneous stenting of the carotid artery when a cerebral protection device is used is feasible and effective but not without potential complications.However, a long learning curve may exist for the proper use of some embolic protection devices.(Stroke.2003;34:1936-1943.