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(Stroke. 2004;35:e20.)
© 2004 American Heart Association, Inc.

Research Report

Editorial Comment—With or Without Protection? The Second Important Question in Carotid Artery Stenting

Department of Neuroradiology, Institute of Diagnostic and Interventional Radiology, University of Essen, Essen, Germany

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

This is already the second editorial comment within the last 6 months about protection devices in carotid artery stenting.¹ Obviously, this seems to be an important question. In the August issue of Stroke, Cremonesi and co-workers reported about their experience with these protection devices and suggested that the use is feasible and effective, but not without complications.²

And now, in this issue, the EVA-3S Trial committee reports the comparison of protected and unprotected stenting procedures.³ Due to the better results when using protection devices, the safety committee recommended stopping unprotected stenting within the study.

From a scientific point of view, this recommendation was not absolutely necessary. A substantial number of patients treated without protection developed a stroke, not during the procedure but during the first 30 days. And this cannot be related to the nonuse of a protection device! However, this is a large randomized study and the reviewers and the editorial board of Stroke decided that the preliminary results have to be published! But, the publication of these results (or should I say, "of this opinion"?) should not be used to change all "stenting" procedures into "stenting with protection" procedures. They should be seen as part of a growing data pool, which it is hoped will allow us one day to make a definite decision based on real evidence. This report is clearly a piece of a puzzle and absolutely not the final proof for the protecting devices. The number of patients treated, the number of complications, and . . . [Full Text of this Article]

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