Dual cerebral protection technique during carotid stenting

Purpose: To present a technique for internal carotid artery stenting (CAS) with dual cerebral protection in patients with high-grade stenosis caused by large, soft atherosclerotic plaques. Technique: The MOMA proximal cerebral protection device is first placed in the external and common carotid arteries. Complete blockade of blood flow is achieved by inflating the occlusion balloons. A Spider filter is delivered to the distal internal carotid artery. All procedural steps of CAS are performed during continuous and simultaneous proximal occlusion and distal filter protection. After postdilation of the stent, the occlusion balloons are deflated, and antegracle flow is re-established with the distal filter basket still open. Conclusion: In selected patients with large atherosclerotic plaques, a dual cerebral protection technique during CAS may be a more efficacious form of cerebral protection than a single protection device.