Author + information
- Juan C. Parodi, MD⁎ ()
- ↵⁎Surgery Department, Washington University, 171 North Central, St. Louis, MO 63501
After reading the study titled “Effect to Two Different Neuroprotection Systems on Microembolization During Carotid Artery Stenting” by Schmidt et al. (1) in the Journaland after having an extensive experience with a system that holds several similarities with the MO.MA device (Invatec s.r.l., Roncadelle, Italy), I can make the following comments.
The investigators stated that 71% of their patients had microembolic signals (MESs) after balloon dilation of the stent; MESs during stent placement and balloon dilation were more than six times higher than during wire passage. This latter observation suggests that antegrade flow was still present using the MO.MA device.
The utilization of balloon occlusion of the common carotid artery (CCA) and external carotid artery (ECA) and the description of continuous MESs during carotid artery stenting (CAS) using a filter device was reported earlier by us (2). The researchers did not reference this original study.
Using occlusion of the CCA and ECA, we experienced, as did Schmidt et al. (1), that MESs were still present; we attributed them to antegrade flow through branches not occluded by the balloon. The other potential explanation is a Venturi effect of the circle of Willis suctioning from the column of stagnant flow in the internal carotid artery after balloon occlusion.
Finally, owing to the above-mentioned findings, we added flow reversed to the occlusion of the CCA and ECA.
- American College of Cardiology Foundation