Triple Balloon Protection Technique Using the Mo.Ma Ultra with the Carotid GuardWire for Carotid Stenting: Technical Note

Background We describe the “triple balloon protection technique” (TBPT) using the Mo.Ma Ultra in combination with the Carotid GuardWire during carotid artery stenting (CAS). This technique is expected to prevent distal embolism to the internal and external carotid arteries, and is suitable for East Asians in whom the origin of the superior thyroid artery is lower than that in Caucasians. Methods From December 2012 to May 2013, 11 patients underwent CAS using TBPT in our center. Results Procedural success was achieved in all patients. Complete flow blockade by angiography could not be obtained in 8 patients (72.7%) by proximal occlusion using the Mo.Ma Ultra only. Complete angiographic flow blockade was obtained in all patients by TBPT. No major adverse cardiovascular events, including stroke, myocardial infarction, or death because of any cause, occurred within 30 days. Conclusions The use of TBPT for CAS may be effective for preventing distal embolisms, especially for East Asians.