title: Effect of two different neuroprotection systems on microembolization during carotid artery stenting.
abstract: OBJECTIVE
  This study sought to compare the efficacy of two different cerebral protection systems for the prevention of embolization during carotid artery stenting (CAS) using a transcranial Doppler (TCD) monitoring with the detection of microembolic signals (MES).
  
  
  BACKGROUND
  Despite the introduction of cerebral protection systems, neurologic complications during CAS cannot completely be prevented. Transcranial Doppler and detection of MES may aid in assessing the efficacy of different neuroprotection systems.
  
  
  METHODS
  A total of 42 patients with internal carotid artery stenoses were treated by CAS using either a filter (E.P.I. FilterWire, Boston Scientific Corp., Santa Clara, California) (n = 21) or a proximal endovascular clamping device (MO.MA system, Invatec s.r.l., Roncadelle, Italy) (n = 21). Microembolic signal counts were compared during five phases: placement of the protection device, passage of the stenosis, stent deployment, balloon dilation, and retrieval of the protection device.
  
  
  RESULTS
  There were no significant differences in clinical or angiographic outcomes between the two groups. Compared to the filter device, the MO.MA system significantly reduced MES counts during the procedural phases of wire passage of the stenosis, stent deployment, balloon dilation, and in total (MES counts for the filter device were 25 +/- 22, 73 +/- 49, 70 +/- 31, and 196 +/- 84 during the three phases and in total, MES counts for the MO.MA system were 1.8 +/- 3.2, 11 +/- 19, 12 +/- 21, and 57 +/- 41, respectively; p < 0.0001).
  
  
  CONCLUSIONS
  In comparison to a filter device the MO.MA system led to significantly lower MES counts during CAS. The detection of MES by TCD may facilitate the evaluation and comparison of different neuroprotection systems.
authors.affiliation: Division of Clinical and Interventional Angiology, Department of Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. Andrej.Schmidt@gmx.de
authors.forename: Andrej
authors.initials: A
authors.lastname: Schmidt
authors.forename: Klaus-Werner
authors.initials: KW
authors.lastname: Diederich
authors.forename: Susanne
authors.initials: S
authors.lastname: Scheinert
authors.forename: Sven
authors.initials: S
authors.lastname: Bräunlich
authors.forename: Tatjana
authors.initials: T
authors.lastname: Olenburger
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Biamino
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016893:Carotid Stenosis / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial