Embolization during carotid reconstruction is the most frequent cause of neurologic complications. Atraumatic surgical technique, intraoperative monitoring of the cerebral circulation and completion imaging all contribute to reduce the risks of embolization. Data from the literature suggest that the incidence of perioperative neurologic events correlate with the number of microemboli demonstrated by transcranial Doppler. Cerebral protection for percutaneous angioplasty with stenting of the carotid artery needs to be introduced, since without protection devices endovascular techniques are associated with > 8 times the rate of microemboli seen during carotid endarterectomy
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