Contemporary review of embolic distal protection strategies in carotid artery stenting.

Stroke is the third most common cause of death in the United States. Approximately 30% of all ischemic strokes are secondary to carotid artery disease. Carotid endarterectomy (CEA) is considered the gold standard for the treatment of carotid artery stenosis. Endovascular techniques such as carotid angioplasty and stenting (CAS) have been proposed as possible alternatives for high-risk patients, but not until the advent of embolic protection devices (EPD) were they considered an acceptable alternative to surgery. There are currently two types of cerebral protection strategies employed: distal protection in the form of an occlusion balloon or filter, and proximal protection in the form of flow interruption or reversal devices. Advantages and disadvantages of each type will be reviewed. The selection of an EPD largely depends on anatomy as well as operator preference. Although there is currently a lack of consensus among interventionists performing CAS on the optimal EPD, all have agreed that routine use of an EPD during CAS is beneficial and mandatory.