Choice of protection devices in carotid angioplasty. Two case reports

Patient selection is of the utmost importance with all endovascular procedures. It is equally important to select the appropriate protection device during carotid angioplasty/stenting (CAS). CAS in two patients was unsuccessful due to the chosen protection device. Occlusion of the external carotid artery while deploying a Parodi Anti-Embolic-System Device (PAEC - ArteriA) resulted in cerebral ischaemia. Conversion to the Angioguard System (Cordis) made carotid angioplasty possible, but was complicated by thrombosis of the filter. In the second case it was impossible to negotiate tortuous vessels with the Angioguard system. Our experience illustrates that both devices have limitations. Choosing the wrong device may have serious consequences.