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Distal Protection: Maybe Less Than You Think

Distal Protection: Maybe Less Than You Think The problem with evidence is that it doesn’t always agree with your facts. —Stephen Colbert Distal protection devices appear seductively simple, elegant, and beneficial to both physicians and patients. Why would you not want to use something called "distal protection?" To not use "distal protection" during carotid angioplasty and stent placement (CAS) sounds irresponsible, like not practicing "safe sex." In a simple world, distal protection devices would do exactly what their name implies, that is, eliminate complications of CAS that are caused by distal emboli. But we do not live in such a simple world. Every medical device has both benefits and risks. To properly characterize the risk-benefit profile of a device, controlled studies are needed, comparing patients treated with the device to patients not treated with the device. That sounds like simple, high school science. But no such study exists. Instead we have retrospective data comparing patients treated before and treated after the introduction of distal protection devices, such as the article in this issue of American Journal of Neuroradiology by Kastrup et al. 1 These authors report that the proportion of patients with new ipsilateral diffusion-weighted imaging (DWI) lesions was significantly lower (52% versus 65%) after http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Distal Protection: Maybe Less Than You Think

American Journal of Neuroradiology , Volume 29 (3): 407 – Mar 1, 2008

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A0879
Publisher site
See Article on Publisher Site

Abstract

The problem with evidence is that it doesn’t always agree with your facts. —Stephen Colbert Distal protection devices appear seductively simple, elegant, and beneficial to both physicians and patients. Why would you not want to use something called "distal protection?" To not use "distal protection" during carotid angioplasty and stent placement (CAS) sounds irresponsible, like not practicing "safe sex." In a simple world, distal protection devices would do exactly what their name implies, that is, eliminate complications of CAS that are caused by distal emboli. But we do not live in such a simple world. Every medical device has both benefits and risks. To properly characterize the risk-benefit profile of a device, controlled studies are needed, comparing patients treated with the device to patients not treated with the device. That sounds like simple, high school science. But no such study exists. Instead we have retrospective data comparing patients treated before and treated after the introduction of distal protection devices, such as the article in this issue of American Journal of Neuroradiology by Kastrup et al. 1 These authors report that the proportion of patients with new ipsilateral diffusion-weighted imaging (DWI) lesions was significantly lower (52% versus 65%) after

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Mar 1, 2008

There are no references for this article.