Proximal embolic protection during carotid stenting: current devices and outcomes

Carotid angioplasty and stenting (CAS) has become established as a safe and effective treatment strategy for patients at high risk for carotid endarterectomy (CEA). The adjunctive use of embolic protection devices has been associated with decreased rates of adverse neurologic events with CAS. Compared to other embolic protection strategies, the use of proximal protection devices during CAS has shown superior outcomes in regards to adverse events at 30 days. In this manuscript, we will compare and contrast the differences between distal embolic protection (EPD) and proximal embolic protection devices (PPD) in terms of procedural techniques, device advantages and limitations, and outcome data from prospective and retrospective clinical studies.