Reversal of blood flow to the brain may help protect against stroke during carotid stenting

Surgeons at the Methodist DeBakey Heart Center in Houston have begun a new trial that will seek to protect patients from stroke by reversing blood flow in the brain during carotid stenting.

“By reversing blood flow in the brain, we hope to prevent small particles from reaching the brain and causing a stroke or problems with speech, memory or pain,” said Dr. Imran Mohuiddin, principal investigator and vascular surgeon at the Methodist DeBakey Heart Center.

During a typical carotid stenting procedure, a tiny metal scaffold is placed in a narrowed carotid artery to prop it open and ensure sufficient blood flow from the heart to the brain. During the stenting process, tiny bits of atherosclerotic debris can come loose and flow into the brain, restricting or blocking oxygenated blood from reaching the brain. By reversing the flow, this debris will not flow towards the brain, so risk of injury may be reduced.

The Gore Neuroprotection System is an investigational device that employs tiny balloons to reverse blood flow. This neuroprotective device will be inserted via catheter in the patient's groin. One tiny balloon will be inflated in the common carotid artery, the main artery of the neck. Another tiny balloon will be inflated in the outer branch of the main artery, the external carotid artery. This causes blood to flow away from the head, allowing loose particles will flow away from the brain.

While the blood flow reversal is active, the surgeon will place the stent in the diseased carotid artery via a catheter in the groin. When the stent is in place, the two balloons will be deflated and blood flow will return to normal.

The EMPiRE (Embolic Protection with Reverse Flow) study is a multi-site trial supported by W.L. Gore & Associates. The study targets patients who are at high risk for carotid endarterectomy, the alternative open surgical procedure that does not use less-invasive catheter-based technology. Fifteen people will take part in this study at Methodist.