Current Indications for Cerebral Protection in Surgery and Endovascular Therapy

Carotid angioplasty, until recently carried out in selected patients at a few specialist centres, is currently growing at a rate of 20% a year. The main limitation on its development to date was the risk of cerebral embolization demonstrated experimentally at each stage of the procedure. Rapid advances in materials, especially the introduction of cerebral protective devices, has opened the way to a rapid expansion in the use of this method thanks to a significant drop in complications during the method's learning curve. Current outcomes are increasingly close to those of traditional surgery. Carotid angioplasty is now a first choice treatment in patients at high risk or unsuitable for surgery. Angioplasty is also growing as an adjuvant rather than alternative treatment to surgery especially in patients presenting anatomical problems. Cerebral protection devices enhancing treatment outcome are not so much an option as a necessity in all these patients as confirmed by ongoing studies (CARESS, PACE, Italian SICVE register) assessing the efficacy of carotid angioplasty using cerebral protection devices. The final results of these studies should establish the best method of cerebral protection and confirm the role of carotid angioplasty in the treatment of carotid artery stenotic disease.