Carotid stenting with double layered stents: Double trouble or double benefit?

The use of double layer (covered) stents during carotid artery stenting (CAS) appears to be safe; attenuation of plaque prolapse and distal embolization is reasonable but unproven. Double layer stents are commercially available in Europe but not in the United States; similar benefits might be obtained by implanting two self-expanding stents, to decrease the effective free cell area. Embolic protection devices (EPDs) are recommended in all CAS patients; the use of double layer stents does not eliminate the need for EPDs.