In vitro evaluation of the effectiveness of distal protection in the prevention of cerebral thromboembolism during carotid stent placement

Rationale and Objectives. The purpose of this in vitro study was to evaluate and quantify the benefit of the balloon protection device, to identify the most effective sequence of irrigation or flushing, and to determine the most effective catheter position to remove the maximum number of emboli or debris beneath the flow-arrest balloon. Materials and Methods. Silicone models of the neurovasculature were attached to a systodiastolic pump. Stents were placed in carotid stenoses by using the distal flow protection technique. Embolic material was released within the stent. The effectiveness of different irrigation techniques was evaluated. Results. Aspiration under the balloon through the guiding catheter with a 60-mL syringe followed by one power injection at 40 mL injected at 2 mL/sec will result in removal of about 98% of potential emboli from the inferior vena cava. Conclusion. In vitro evaluation of the distal flow protection technique indicates that it should reduce stroke risk during carotid stent placement.