Critical analysis of distal protection devices.

There is considerable evidence that embolization takes place universally during all carotid stenting procedures. In addition, the development of sophisticated distal protection devices and their availability made the concept of cerebral protection widely acceptable, and currently there is a consensus among specialists that protection devices need to be used routinely. The results of the SAFER trial as well as the SAPPHIRE trial have further increased the enthusiasm for routine use of protection devices. However, each additional step to an existing procedure adds potential risks to the procedure. This is true for cerebral protection devices. The problems associated with the use of a distal protection device relate to (1) difficulties in introducing and deploying the device, (2) effectiveness of emboli capture, (3) protection device induced vessel injury, and (4) difficulties in retrieving the device. This article reviews the early clinical experience with various protection devices and summarizes some of the disadvantages of these devices.