The Role of Embolic Protection in Carotid Stenting Progress in Cardiovascular Diseases (PCVD)

Embolic protection device (EPD) use has become ubiquitous and is currently mandated by the Centers for Medicare and Medicaid (CMS) for reimbursement in conjunction with carotid artery stenting (CAS). There are two classes of EPD devices: distal filter EPD (f-EPD) and proximal EPD (p-EPD). Measuring the incremental benefit of one strategy over the other remains problematic for several reasons. The first lies in the difficulty of defining an embolic event as transcranial Doppler and diffusion-weighted magnetic resonance imaging abnormalities may not correlate with clinical events. Next, f-EPD is used more frequently than p-EPD making direct comparisons challenging, as analyses to this point have been underpowered. However, there are several promising emerging techniques and technologies that warrant further investigation.