Proximal protection device in carotid artery stenting

Proximal protection device in carotid artery stenting

Proximal protection device in carotid artery stenting: Proximal protection devices can be used in internal carotid artery stenting to protect the cerebral circulation. One device known as the Mo.Ma device, has been evaluated in the ARMOUR trial. The device offers proximal embolic protection based on the principle of endovascular clamping with two compliant balloons at the distal end. The balloons can be independently inflated and deflated. There is a central lumen which allows the passage of interventional devices. It provides the blockage of anterograde and retrograde flow at the carotid bifurcation. The distal balloon is placed in the external carotid and the proximal balloon in the common carotid artery. The embolic particles can be withdrawn by manual syringe aspiration at the end of the procedure before restoring blood flow through the stented vessel.

The ARMOUR trial (http://clinicaltrials.gov/ct2/show/NCT00744523) assessed the primary end points of cardiac and cerebrovascular events (MACCE) within 30 days of implantation, defined as myocardial infarction, stroke or death. The trial was done in those with at least one of the high surgical risk criteria. Single target lesions of 80% or more in asymptomatic individuals and 50% or more in symptomatic individuals were recruited for the trial. The 30 day stroke rate was 2.3% and MACCE rate was 2.7%. The reference diameter of the external carotid artery should b 3-6 mm and that of the common carotid artery between 5-13 mm for the current device.

PRIAMUS was an Italian prospective registry which evaluated the proximal protection earlier [1].

Dual cerebral protection with both the proximal protection device and a distal protection filter device has also been evaluated [2].

References

  1. G Coppi, R Moratto, R Silingardi, P Rubino, G Sarropago, L Salemme, A Cremonesi, F Castriota, R Manetti, S Sacca, B Reimers. PRIAMUS–proximal flow blockage cerebral protectIon during carotid stenting: results from a multicenter Italian registry. J Cardiovasc Surg (Torino). 2005 Jun;46(3):219-27.
  2. Zoran V Milosevic, Igor J Kocijancic, Matjaz Bunc, Fajko F Bajrović, Bojana Zvan. Dual cerebral protection technique during carotid stenting. J Endovasc Ther. 2007 Feb;14(1):86-90. doi: 10.1583/06-1926.1.