Cerebral protection devices (CPD) have a central role for cerebral complication reduction during CAS procedure . Different kinds of CDP are currently available attempting to reduce the chances of clinically significant neuro-embolism. However, despite the use of CPD, potentially devastating thromboembolism events cannot be completely prevented . Generally first treatment of this kind of complication is based on pharmacological endovenous fibrinolysis associated or not with local fibrinolysis by dedicated neurological catheter. However, this kind of therapy may present several contraindications because of the risk of cerebral haemorrhage. In our case we weren’t able to use pharmacological therapy because of haemostasis alteration due to warfarin therapy for atrial fibrillation. In this case one opportunity may be mechanical trombectomy using dedicated systems. Recently several devices have been introduced for acute stroke treatment. The Penumbra Stroke System with its aspiration catheters, wires and aspiration pump allows a combined mobilisation and aspiration of the thrombus. These devices associated to intracerebral angioplasty balloon and stenting may give a new challenge to treat this kind of complications avoiding any consequences for the patient .
The most important issue to obtain a good resolution of these complications may be the fast and methodological treatment of the disease. If a cerebral embolism occurs during a CAS or ISR treatment, like in our case, it is fundamental complete carotid procedure quickly allowing the subsequent treatment of distal embolism.
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