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(Stroke. 2003;34:1941.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Carotid Artery Stenting With or Without Protection Devices? Strong Opinions, Poor Evidence!

Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In recent years, endovascular treatment of carotid artery stenosis has profited from substantial technical improvements, but the dominant point of discussion circles around the so-called cerebral protection devices. In this issue of Stroke, Cremonesi et al¹ report their impressive single-center experience with protected carotid artery stenting (CAS) in 442 patients. The overall complication rate was 3.4%, and the 30-day ipsilateral stroke/death rate was 1.1%. The authors conclude that protection devices are feasible and effective in preventing distal embolization. In a recent Stroke issue, Kastrup et al,² who systematically reviewed single-center CAS studies, concluded that protection devices appear to reduce thromboembolic complications during CAS.

The appearance of debris during CAS and carotid endarterectomy (CEA) is a common event.^3,4 At first glance, it seems reasonable to apply protection systems to catch particles by means of occlusive balloon systems or filtration baskets in the internal carotid artery. The beneficial use of such devices seems to be supported by a growing number of publications, mostly from the field of cardiology, reporting declining neurological complication rates. Despite the lack of further controlled studies, the use of protection devices has even become obligatory in the CREST (United States)⁵ and EVA3S (France) trials testing for equivalence of CAS and CEA.

Paradoxically, some neuroradiologists continue to successfully perform CAS without protection devices and hesitate to apply protection devices that demand an increase in both catheter time and technical complexity. In centers in which experience with unprotected CAS has been gathered, skepticism about the assumed self-evident improvement on . . . [Full Text of this Article]

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