Double filters: A protection technique for high-risk innominate artery angioplasty

摘要

We read with interest the commentary by Guimaraes et al., in which they related a case of protected innominate artery (IA) stenting using left subclavian artery balloon occlusion to divert flow to a single internal carotid artery (ICA) filter, thus protecting both circulations. Typically, embolic protection has not been considered necessary in IA angioplasty; data from a large prospective registry indicated that non-neuroprotected angioplasty for symptomatic IA stenosis can be perform with a very low risk (<1%) of cerebral complications.On the other hand, in the largest series of IA angioplasty, the rate of cerebral ischemic complications was as high as 8%. After witnessing a devastating ipsilateral stroke in a patient undergoing unprotected IA stenting, we began using a dual filter system to protect both circulations during IA stenting in patients at high risk of embolization.