{"id":15602,"date":"2012-01-25T17:40:36","date_gmt":"2012-01-25T22:40:36","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&#038;p=15602"},"modified":"2012-01-26T12:00:56","modified_gmt":"2012-01-26T17:00:56","slug":"heads-up-lesions-down-on-a-new-embolic-protection-device-for-carotid-arterial-stenting","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/01\/25\/heads-up-lesions-down-on-a-new-embolic-protection-device-for-carotid-arterial-stenting\/","title":{"rendered":"Heads Up (Lesions Down) on a New Embolic Protection Device for Carotid Arterial Stenting"},"content":{"rendered":"<p>The current\u00a0standard of care\u00a0for\u00a0individuals undergoing carotid arterial stenting (CAS)\u00a0entails\u00a0the use of\u00a0an embolic protection device (EPD) to minimize the risk for embolic stroke. At present, the only FDA-approved EPD is a filter that is placed distal to the stenosis (i.e., it is advanced across the lesion) before stenting.<\/p>\n<p>In <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/abstract\/j.jacc.2011.11.035v1\">a\u00a0recently completed randomized trial<\/a>,\u00a0a proximal balloon occlusion\u00a0device provided better cerebral protection during CAS than a distal filter device.\u00a0Compared with distal filter protection, proximal balloon occlusion resulted in a significant reduction in the incidence of new cerebral ischemic lesions, as assessed by diffusion-weighted MRI (45.2% vs. 87.1%,\u00a0<em>P<\/em>=0.001).\u00a0The rate of major adverse cardiovascular and cerebral events\u00a0at 30 days did not\u00a0differ\u00a0between the two devices, although the study was underpowered to detect such a difference.<\/p>\n<p>The author of <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/full\/j.jacc.2011.12.006v1\">an accompanying editorial<\/a> finds these results \u201csensible, since in contrast to distal EPDs, proximal EPDs provide embolic protection prior to crossing the target lesion with a guidewire, and should be more efficient at capturing and removing debris since they are not dependent on filter pore size or particle dimensions.\u201d<\/p>\nSorry, there are no polls available at the moment.\n<p><strong><em>Is this a game changer for you?<\/em><\/strong><\/p>\n<p><strong><em>In your patients with asymptomatic severe carotid arterial stenosis (&gt;70% diameter narrowing), do you recommend medical therapy, endarterectomy, or stenting?<\/em><\/strong><\/p>\n<p><strong><em>Would the use of a better EPD change your management strategy?<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The current\u00a0standard of care\u00a0for\u00a0individuals undergoing carotid arterial stenting (CAS)\u00a0entails\u00a0the use of\u00a0an embolic protection device (EPD) to minimize the risk for embolic stroke. At present, the only FDA-approved EPD is a filter that is placed distal to the stenosis (i.e., it is advanced across the lesion) before stenting. In a\u00a0recently completed randomized trial,\u00a0a proximal balloon occlusion\u00a0device [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[994,1129,1127,1130,1128],"class_list":["post-15602","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-carotid-artery-stenting","tag-distal-embolic-filter","tag-embolic-protection-device","tag-profi","tag-proximal-balloon-occlusion"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15602","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=15602"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15602\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=15602"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=15602"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=15602"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}