Current concepts of mechanical cerebral protection during precutaneous carotid intervention

Major advances in the endovascular treatment of carotid artery stenosis are underway, with an emphasis on improving the safety profile of the technique. This review highlights key areas in the concepts and design of available mechanical neuroprotection devices utilized during carotid stenting to minimize procedural cerebral embolization. The advantages and disadvantages of each system are explored and the available clinical experience is given. The size threshold of particulate material likely to be clinically relevant is examined and compared with pathological analysis of particles trapped by protection systems reported in the world literature. It is shown that the adverse neurological event rate in those protected is lower than that in historical studies of unprotected carotid stenting. Furthermore, the size range and numbers of particles trapped by protections systems are sufficient to cause potential neurological injury if allowed passage to the brain. Further improvements in outcomes may require further refinement of protection technology.