title: Microembolization during carotid stenting with the distal-balloon antiemboli system.
abstract: BACKGROUND
  The distal-balloon protection system is being evaluated for its efficacy in preventing embolic neurological events during carotid stenting (CAS). We sought to determine the effect of this system on the frequency of the Doppler-detected microembolic signals (MES) during CAS.
  
  
  METHODS
  Using transcranial Doppler, we compared the frequency of MES during CAS in 2 groups; 39 patients without distal protection and 37 with the distal-balloon protection system (GuardWire, Percusurge, Sunnyville, CA). There was no significant difference in the clinical or angiographic characteristics between the 2 groups. Three phases with increased MES counts were identified during the unprotected CAS; stent deployment, predilation, and postdilation (mean+/-SD: 75+/-57, 32+/-36, and 27+/-25, respectively).
  
  
  RESULTS
  The distal-balloon protection significantly reduced the frequency of MES during CAS (MES-counts: 164+/-108 in the control vs 68+/-83 in the protection group, p=0.002) particularly during these 3 phases. MES in the protection group were detected predominantly during sheath placement, guidewire manipulation and during the distal-balloon deflation.
  
  
  CONCLUSIONS
  Three phases with increased MES counts were identified during the unprotected CAS, e.g. stent deployment, predilation and postdilation. The distal-balloon protection system significantly reduced the frequency of MES during CAS, particularly during these 3 phases.
authors.affiliation: Endovascular Therapeutics, University Hospital System of Cleveland, OH 44145, USA. NALmubarak@aol.com
authors.forename: N
authors.initials: N
authors.lastname: Al-Mubarak
authors.forename: G S
authors.initials: GS
authors.lastname: Roubin
authors.forename: J J
authors.initials: JJ
authors.lastname: Vitek
authors.forename: S S
authors.initials: SS
authors.lastname: Iyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial