Performed with an embolic protection device (most commonly a distal filter, occasionally proximal balloon occlusion/flow-reversal systems) deployed before lesion crossing to capture debris dislodged during the procedure, given the direct stroke risk from cerebral embolization. Patient selection weighs surgical risk (favoring stenting in high surgical-risk patients) against anatomic factors that affect stenting feasibility (severe vessel tortuosity, heavy calcification at the lesion).
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