However, carotid stenting has faced a great deal of criticism, particularly from the surgical community. By virtue of its proximity to the brain, the procedure requires precise technical skill. The procedure has been faulted because of the associated increased risk of stroke, resulting from released particle debris at the treated site that travels up the bloodstream to the brain. Distal embolic protection devices have emerged as a means to reduce the incidence of stroke during stenting by collecting and trapping particle debris during the reperfusion procedure. The approach had not previously been widely studied in carotid artery stenting patients. The study was unique in that both surgeons and interventional cardiologists had to meet certain procedural criteria to participate in the study. Surgeons were required to have ample surgical expertise with CEA procedures, defined as having performed an average of 30 CEAs annually (procedural range 15-100) with a corresponding low rate of major complications (stroke, death, or myocardial infarction < 1%).
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