Transcranial Doppler monitoring during stenting of the carotid bifurcation: evaluation of two different distal protection devices in preventing embolization.
OBJECTIVE
To compare the efficacy of 2 emboli protection devices in preventing embolization during carotid artery stenting (CAS).


METHODS
The GuardWire distal occlusion system (n=19) and the distal FilterWire EX (n=12) were compared in 31 consecutive patients (24 men; mean age 71+/-10 years) monitored with transcranial Doppler for microembolic signals before, during, and after CAS. The choice of the protection device was based on availability and on the patency of the contralateral carotid artery.


RESULTS
The baseline characteristics were similar in the patients treated under protection from either device. Placement and retrieval of the protection device, stenting, and postdilation were technically successful in all patients. Two patients suffered a transient ischemic attack shortly after the procedure; no other adverse cardiovascular events occurred at 30 days. Compared to the GuardWire, the use of the FilterWire was associated with more microembolic signals during stent deployment (77.4+/-33.5 versus 1.07+/-1.94, p<0.0001), postdilation (63.9+/-21.0 versus 2.06+/-2.58, p<0.0001), and retrieval of the protection device (21.4+/-15.4 versus 10.9+/-8.3, p=0.051). Consequently, the total amount of microembolic signals during the procedure was higher when the filter device was employed (183.0+/-42.1 versus 31.7+/-12.0, p<0.0001).


CONCLUSIONS
The distal occlusion device appears to be more effective than the filter in reducing distal embolization detected by transcranial Doppler monitoring.
Rubartelli
Paolo
P
Division of Cardiology, Ospedale San Martino, Genoa, Italy. paolo.rubartelli@villascassi.it
Brusa
Giulia
G
Arrigo
Alessandro
A
Abbadessa
Francesco
F
Giachero
Corinna
C
Vischi
Massimo
M
Ricca
Maria Maddalena
MM
Ottonello
Gian Andrea
GA
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial