Protected carotid stenting

To optimize the safety of endovascular treatment and to prevent embolic com plications. Theron's technique of carotid stenting under balloon protection was applied successfully to 31 patients with high grade extracranial carot id stenoses. Dilatation of the stenosis and stent deployment are performed under temporary balloon occlusion of the distal internal carotid artery. Bl ood flow is restored after aspiration as well as flushing of potential embo li from the external carotid territory. Initially a hand-mounted non-steera ble protection balloon catheter caused technical difficulties in the passag e of some stenoses with irregular plaque surfaces. Steerable guide wires wi th integrated balloons improved the technical feasibility of the protection technique. Up to now no periprocedural strokes were observed. Microscopic examination of the aspirated blood showed numerous cholesterol crystals and fat particles with sizes up to 600 mu which in model experiments with the use of pulsatile perfused silicone carotids showed the effectiveness of asp iration and flushing in the elimination of embolic particles. We assume tha t the meshwork of the stent, antiplatelets and periprocedural anticoagulati on provide no sufficient protection against materials released from the nec rotic core of the atherosclerotic plaque. The proven presence of microembol i as well as low clinical rates are arguments for further use and developme nt of the protection technique.