Distal flow protection during carotid stenting: A prospective study to quantify the embolic debris retrieved in the internal carotid artery territory

This study was conducted to evaluate presence of embolic debris during ICA stent procedures. Nine patients with severe carotid atheromatous stenosis were treated by stent implantation under distal flow protection using a non-detachable balloon. After stent implantation, the lumen of the ICA was cleaned by aspiration of 50 cc of blood before further flush cleaning and deflation of the protection balloon. The blood samples obtained from each patient were analyzed using a microscope to check quantity and aspect of embolic debris. Significant numbers of embolic debris were recovered from blood samples in all nine stenting cases, but very few were found in four out of the five control cases. This observation demonstrates the high risk of producing embolic debris during carotid stenting. Distal balloon occlusion and cleaning procedures are techniques to provide protection from thromboembolic complications to the brain.