Evaluation of Balloon Guide Catheter as Proximal Protection During Carotid Artery Stenting (EMBO-PROTECT)

Carotid angioplasty and stenting (CAS) is an effective treatment for carotid artery stenosis but carries a risk of cerebral embolization. This prospective randomized study evaluates the safety and efficacy of proximal embolic protection using a balloon guide catheter during CAS by comparing the incidence of diffusion-weighted MRI-detected microembolisms and symptomatic thromboembolic events between protected and unprotected procedures.

Inclusion Criteria: * Age ≥ 18 years * Symptomatic or asymptomatic carotid artery stenosis * Candidate for carotid artery stenting * Written informed consent provided Exclusion Criteria: * Vascular anatomy unsuitable for balloon guide catheter placement * Severe renal failure * Previous disabling stroke or symptomatic intracranial hemorrhage * Evidence of carotid thrombus * Severe common carotid artery lesion * Chronic atrial fibrillation on oral anticoagulation * Acute coronary syndrome within 30 days * Contraindications to anticoagulant or antiplatelet therapy * Contraindications to MRI * Contrast media allergy * Lack of prior dual antiplatelet therapy