Dr Colombo obtained his MD from the University of Milan, followed by residency at Milan and New York, chief residency at New York and fellowships at the University of California at Irvine and State University of New York in Syracuse. Dr Colombo has devoted time and effort throughout his distinguished career to defining the indications and limitations of coronary stenting. He pioneered the concept of adequate stent deployment during coronary interventions and defined the role of intravascular ultrasound in this setting, and contributed to redefining adequate anticoagulation after coronary stenting. Dr Colombo has published extensively in prestigious cardiology journals, is active in many medical societies and is on the Editorial Board of all major cardiovascular journals. He is recognised worldwide as an authority in interventional cardiology.

Antonio Colombo and
Ioannis Iakovou
Cardiac Catheterization Laboratory, Centro Cuore
Columbus, and San Raffaele Hospital, Milan, Italy

Address for correspondence:
Dr Antonio Colombo
Department of Interventional Cardiology
Columbus Hospital
Via Buonarroti 48, 20145 Milan, Italy
Tel: +39-(0)-2-481-2920
Fax: +39-(0)-2-4-819-3433
Email: info@emocolumbus.it

Abstract
Although endarterectomy is today considered the gold-standard therapy for the treatment of carotid artery stenosis, the approach is not free of complications. Carotid artery stenting (CAS) has rapidly emerged as an equivalent alternative to surgery for the treatment of extracranial carotid artery disease. Percutaneous stenting is accomplished at the expense of an increased incidence of microemboli. These emboli are associated with a higher neurological complication rate and are also recognised as a potential cause of periprocedural stroke during carotid endarterectomy (CEA). Numerous embolic protection devices are being evaluated as an adjunct to CAS including (1) occlusion balloons, (2) distal filters, and (3) retrograde flow devices. The filter devices are the more promising since they offer the ability to trap embolic debris while maintaining distal cerebral perfusion. They also allow angiographic monitoring of the angioplasty and stent placement concomitant with protection. Their use during CAS has reduced the rate of periprocedural acute cerebral ischaemic complications, thus enhancing the safety of the percutaneous approach, which can therefore be carried out with good results even in high-risk patients. Recently published non-randomised data suggested that unprotected CAS carries a 3.9 times higher risk than the protected CAS for 30-day rate of stroke than of CAS with cerebral protection. Despite the absence of solid scientific data based on randomised trials, carotid filters for cerebral protection have become the standard of care in CAS. Whether this practice underscores the future of protection devices for CAS remains to be seen.