Protective or Pretentious? A Critical Appraisal of Embolic Protection Devices in Carotid Artery Stenting: Four-year Experience From a High-volume Tertiary Centre

A BSTRACT Introduction: Carotid artery stenosis is a significant cause of ischaemic stroke. Carotid artery stenting (CAS) is an established alternative to endarterectomy, with embolic protection devices (EPDs) introduced to reduce periprocedural embolic events. Aim and Objective: This study aimed to compare the clinical outcomes of CAS performed with and without EPDs in patients treated at BYL Nair Charitable Hospital, Mumbai. Materials and Methods: A retrospective analysis of 63 patients undergoing CAS between May 2020 and April 2024 was conducted. Patients were divided into two groups: CAS with EPD ( n = 43) and CAS without EPD ( n = 20). Clinical parameters, procedural details, complications, hospital stay and short-term outcomes were evaluated. Results: Out of 63 cases, 40 were male and 23 were female. Hypertension and diabetes were common co-morbidities. The EPD group demonstrated a lower incidence of periprocedural transient ischaemic attack and myocardial infarction compared to the non-EPD group. Silent cerebral embolic lesions on diffusion-weighted magnetic resonance imaging were also reduced in the EPD group. Hospital and intensive care unit stays were shorter in patients with EPD use. Mortality occurred exclusively in the non-EPD group. Conclusion: Use of EPDs during CAS is associated with reduced periprocedural complications and shorter hospitalisation. While CAS without EPD remains a viable option in selected cases, routine use of EPDs should be considered to enhance procedural safety, especially in resource-limited settings.