Aortic arch catheterization during transfemoral carotid artery stenting: an underestimated source of cerebral emboli

Cerebral embolization is still a major concern in patients undergoing transfemoral carotid artery stenting. Intraoperative transcranial Doppler (TCD) monitoring and diffusion-weighted magnetic resonance imaging (DW-MRI), two techniques currently used to study this phenomenon, have provided data suggesting the importance of aortic arch catheterization in determining the overall embolic load observed during this procedure. In order to reduce this cerebral embolization, some Authors have proposed the performance of carotid artery stenting through a cervical access, either surgical or percutaneous. We review in this article the available TCD and DW-MRI data supporting transcervical CAS, along with its clinical results.