The combined use of proximal and distal protection devices uring carotid stenting: a case report

Despite the development of modern medical technologies, cerebrovascular disease remains a major health and social issue. Among all the cases of ischemic stroke, approximately 20% are attributable to stenotic lesions in the carotid artery. The main drawback of carotid stenting is the risk of embolic complications during the procedure. To resolve this problem, various devices that protect against embolism have been developed. In this clinical case, we describe the ability to minimize the risk of operative stroke through a combined application of the distal and proximal protection systems in carotid stenting. In our patient, a 65-year-old woman, angiography of the carotid arteries revealed an ulcerated atherosclerotic plaque of the right internal carotid artery, with stenosis of the lumen of up to 95%. Considering the high risk of distal embolism, the Mo MaUltra (Italy) proximal protection system was used. When evaluating the installation of the Mo MaUltra system, the preserved blood flow through the superior thyroid artery and, therefore, the antegrade blood flow in the internal carotid artery was revealed. Considering the identified risk and the anatomy of the plaque surface, we decided on the additional use of the distal SpiderFX (USA) protection device. The combined use of proximal protection system and distal protective device for carotid stenting is technically possible and may reduce the risk of embolic complications.