Author: Prof. Dr. Piotr Musialek
Institution: Department of Cardiovascular Diseases, Jagiellonian University, Kraków, Poland
Summary
This presentation focuses on optimizing the use of proximal protection devices (Prox EPD) in carotid artery stenting (CAS) to improve outcomes and reduce stroke risk. Through specific cases and operational experience, Prof. Musialek discusses key technical aspects of using proximal protection devices, including flow reversal and stent optimization, to achieve optimal neuroprotection.
Application of Proximal Protection Devices in CAS
• Necessity of Proximal Protection: CAS poses a high embolization risk; proximal protection devices effectively prevent stroke caused by microembolization. Prof. Musialek emphasizes the importance of selecting the right device to minimize embolization risk.
•Optimization Strategies: Key techniques include mastering reverse flow control, using antithrombotic stents, ensuring accurate stent deployment, following the device’s instructions for use (IFU), and applying appropriate anticoagulation measures (e.g., ACT > 250 seconds) to reduce stroke incidence.
Clinical Application and Case Analysis
• Case Example: In a CAS procedure for a 60-year-old patient, correct application of a proximal protection device achieved optimal revascularization and embolic protection, with postoperative imaging showing high safety and effectiveness.
• Advantages of Flow Reversal: Unlike simple flow blockade, reverse flow control effectively minimizes emboli entry into cerebral vessels, providing an advantage in complex lesions.
Key Optimization Points
1.Technical Mastery: Proper use of reverse flow technology in protection devices ensures enhanced neuroprotection.
2. Stent and Protection Device Coordination: Coordinating antithrombotic stents with protection devices achieves both revascularization and embolic protection goals.
3. Device Management: Adhering to device instructions and maintaining effective anticoagulation measures contribute to procedural success.
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