Embolic protection devices for carotid artery stenting: have they made a significant difference in outcomes?

Carotid angioplasty and stenting (CAS) is a valid alternative to conventional carotid endarterectomy for treatment of carotid artery stenosis in a select group of patients. Distal embolization of atherosclerotic debris and air causing neurologic deficits during CAS has been one of the most significant concerns limiting widespread application of CAS technology. A variety of distal embolic protection devices have been designed to minimize the risk of major embolization causing stroke. This review will examine the types of available devices, including strengths and weaknesses of each, and present the available evidence and rationale for their routine use during CAS.