title: Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices.
abstract: We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0 +/- 6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P = 0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS.
authors.affiliation: Department of Neurosurgery, Mie University School of Medicine, 2-174, Edobashi, 514-8507, Tsu City, Mie Prefecture, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Asakura
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakaida
authors.forename: Naoki
authors.initials: N
authors.lastname: Toma
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsushima
authors.forename: Keita
authors.initials: K
authors.lastname: Kuraishi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanemura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Miura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maeda
authors.forename: Waro
authors.initials: W
authors.lastname: Taki
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D015607:Stents; D016896:Treatment Outcome