Cerebral protection devices for treatment of carotid stenoses. Where do we stand today?

The carotid bifurcation is currently a subject of controversial discussion within the vascular territory. These controversies are obvious for diagnostic imaging but the more so for therapy. Performing stenting as a treatment tool, controversies exist also as to whether angioplasty is performed without or obligatory with cerebral protection. Theron and colleagues first described the concept of cerebral protection during carotid angioplasty and stent placement. Currently, there are three temporary cerebral protection systems, i.e. balloon occlusion, filtration baskets, and systems for flow reversal in the internal carotid artery. While these systems provide a considerable degree of protection, as has been shown in in vitro and preliminary clinical studies, embolization might still occur, even under protection. In addition, it is still not clear what the minimum size of emboli is that need to be stopped to prevent a stroke, and what the relevance of cerebral microemboli is. Clinical evidence suggests that the usage of protection systems favours a good outcome of the intervention: however, whether or not such systems should be used routinely remains a matter of discussion and should thus be verified in further clinical studies. (orig.)