Balloon-protected carotid angioplasty

OBJECTIVE: We describe a method of protecting the distal cerebral circulati on during carotid angioplasty and report results using the technique in 17 procedures. METHODS: Eleven men and five women with carotid stenoses ranging in severit y from 70 to 95% underwent the procedure, The technique was used bilaterall y in one patient. A compliant silicone balloon was used to occlude the dist al internal carotid artery during the angioplasty phase, when the largest n umber of emboli are generated. After angioplasty, debris was then flushed i nto the external circulation while the occlusion balloon remained inflated, The subsequent passage of an exchange guidewire through the angioplasty ca theter, with the occlusion balloon deflated, allowed continuous guidewire a ccess across the area of stenosis and facilitated the subsequent placement of a stent. RESULTS: The technique was successful in 16 (94%) of 17 procedures. In the one patient in whom the occlusion balloon could not be advanced across the stenosis, the patient experienced a transient ischemic attack after subsequ ent angioplasty that was performed without protection. Otherwise, no compli cations occurred among the 15 patients undergoing successful, balloon-prote cted angioplasty, Inflation times for the occlusion balloon did not exceed 5 minutes in any patient. CONCLUSION: this method of cerebral protection prevents the intracranial em bolization of thrombus and atherosclerotic debris, while allowing continuou s guidewire access across the site of stenosis, The success of this techniq ue and a similar method used by Theron et al, supports the use of balloon p rotection as a means of reducing the risk of stroke associated with carotid angioplasty.