No. of Recommendations: 5
The sales rep's claim, at least in the peripheral vascular space, is that shocking the calcium does not cause emboli. I would also venture to say that it is less likely calcium that is the problem than non calcified plaque, similar to what we see in the coronary arteries.

You could combine the two or add more and more devices for incremental benefit but then why bother reversing flow when you (theoretically) have no emboli? It makes things more and more expensive for little if any incremental benefit.

I am still not buying the fact that direct carotid puncture is safer than a femoral puncture. I have been involved with some studies for these needs devices. They take a select number of experts in the procedure (who often have a professional and/or financial stake in the procedure succeeding) who take extreme care then compare it to published literature where all sorts of people are doing the existing procedure.
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