Balloon-protected carotid angioplasty

We describe a method of protecting the distal cerebral circulation during carotid angioplasty and report results using the technique in 17 procedures.

Eleven men and five women with carotid stenoses ranging in severity from 70 to 95% underwent the procedure. The technique was used bilaterally in one patient. A compliant silicone balloon was used to occlude the distal internal carotid artery during the angioplasty phase, when the largest number of emboli are generated. After angioplasty, debris was then flushed into the external circulation while the occlusion balloon remained inflated. The subsequent passage of an exchange guidewire through the angioplasty catheter, with the occlusion balloon deflated, allowed continuous guidewire access across the area of stenosis and facilitated the subsequent placement of a stent.

The technique was successful in 16 (94%) of 17 procedures. In the one patient in whom the occlusion balloon could not be advanced across the stenosis, the patient experienced a transient ischemic attack after subsequent angioplasty that was performed without protection. Otherwise, no complications occurred among the 15 patients undergoing successful, balloon-protected angioplasty. Inflation times for the occlusion balloon did not exceed 5 minutes in any patient.

This method of cerebral protection prevents the intracranial embolization of thrombus and atherosclerotic debris, while allowing continuous guidewire access across the site of stenosis. The success of this technique and a similar method used by Theron et al. supports the use of balloon protection as a means of reducing the risk of stroke associated with carotid angioplasty.