proximal balloon protection

There is a lack of consensus on indications for carotid stenting in the field of neurointervention, despite the widespread use of this intervention for a variety of reasons including inoperability. A number of publications have addressed the use of distal protection devices, and have concluded that these devices do not benefit the (imaging) outcome of patients. A potential explanation may be that the devices used are not adequately functioning or that the passage through the stenosed portion in itself carries risk. Furthermore, the use of proximal protection devices has to date resulted in highly complicated procedures and involves very expensive equipment. We describe two cases in which a proximal protection and aspiration with the Penumbra pump was utilized with only limited minimal modification to the usual procedure.