Dr Bernard Reimers is currently Head of the Cathlab in the Department of Cardiology, Mirano General Hospital,Venice, Italy. Prior to this, he was an Assistant in Interventional Cardiology at the Centro Cuore in Milan. Professor Reimers trained, and specialised in Cardiology, at the University of Padova, Italy, and has also worked in both the UK and the Netherlands.

Bernhard Reimers
Cardiology Department, Mirano Hospital, Mirano, Italy

Address for correspondence:
Dr Bernhard Reimers
Cardiology Department
Mirano Hospital
Via Mariutto 13, 30035 Mirano, Italy
Tel: +39-(041)-579-4261
Fax: +39-(041)-579-4309
Email: ulss13mir.card@tin.it

Abstract
Carotid artery stenting (CAS) is emerging as a less invasive alternative to carotid endarterectomy, although embolic neurological events occur invariably during CAS. These are often attributable to fragments of atheromatous plaque dislodged during the stenting procedure. Use of a protection device can minimise this risk, and three approaches have been developed: distal occlusive balloons, distal filters and proximal protection by occlusion of common and external carotid arteries. Distal protection devices must cross the lesion for correct positioning and therefore carry a risk of causing embolisation in the absence of cerebral protection. In contrast, proximal systems provide cerebral protection before any device passes the lesion and therefore should enable complete prevention of embolisation. Despite the lack of randomised trials evaluating these devices, available data indicate superiority of protected over unprotected CAS. The capture of debris and prevention of emboli, few device-related complications and technological improvements in newer devices support the use of cerebral protection for CAS.

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