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(Circulation. 2001;104:2.)
© 2001 American Heart Association, Inc.

Editorials

Carotid Filters

New Additions to the Interventionist’s Toolbox

David O. Williams, MD

From the Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, Providence, RI.

Correspondence to David O. Williams, MD, Division of Cardiology, APC 814, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903. E-mail dowilliams@lifespan.org

Key Words: Editorials • carotid arteries • atherosclerosis • stents

Although percutaneous, catheter-based treatment for atherosclerotic arterial obstruction began in the peripheral circulation, usage became widespread only after coronary application. The procedure’s abilities to relieve angina and either spontaneous or provoked myocardial ischemia and to achieve prompt reperfusion in myocardial infarction are well-documented.¹ Even selected patients with advanced, multivessel coronary disease can expect outcomes similar to those provided by the more invasive bypass surgery.^{2 3 4} Now, enthusiasm for catheter revascularization is circling back to arteries beyond the coronary circulation.

Among these new targets are the carotid arteries, which are well recognized as sources for cerebral emboli, a major cause of stroke. Surgical endarterectomy is performed for severe, symptom-related carotid atherosclerosis and, in selected asymptomatic patients, it seems superior to medical treatment alone in preventing stroke.^{5 6 7} Using approaches and techniques developed from coronary intervention, clinician-investigators have demonstrated that balloon angioplasty and stent deployment are feasible for narrowings involving the internal and external carotid and its bifurcation. Initial observational results are encouraging to the point where a direct comparison of catheter-based therapy to carotid endarterectomy has begun in the form of a large, multicenter, randomized, clinical trial.⁸

Distal embolization of atherosclerotic debris as a consequence of balloon angioplasty has been an issue of concern since the inception of the procedure. Fearful of emboli, Andreas Gruentzig drained, filtered, and examined blood from the coronary sinus when he first performed coronary balloon angioplasty in man (Andreas Gruentzig, MD, personal communication, August 1978). With the exception of degenerated saphenous aortocoronary vein grafts and native arteries with . . . [Full Text of this Article]

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