Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device.
OBJECTIVE
Protected carotid artery stent placement is currently under clinical evaluation as a potential alternative to carotid endarterectomy. The current study was undertaken to determine the incidence of new ischemic lesions found on diffusion-weighted MR imaging (DWI) in nonselected patients after protected carotid artery stent placement using a filter device and to determine the potential relationship between these new ischemic lesions and the presence or absence of a clear amount of debris captured by the neuroprotection filter device.


METHODS
A nonrandomized cohort of 52 patients (40 men, 12 women) presenting with carotid occlusive disease underwent protected carotid artery stent placement using a filter device. DWI obtained 1 day before stent placement was compared with that obtained 1 day after stent placement. In addition, the macroscopic and microscopic analysis of debris captured by the filter device during the carotid stent placement procedure was assessed.


RESULTS
Neuroprotected carotid stent placement was technically successful in all 53 procedures but was complicated by a transient ischemic attack in 3 patients (5.6%). In 22 patients (41.5%), new ischemic lesions were found on DWI, and in 21 filter devices (39.6%), a substantial amount of atheromatous plaque and/or fibrin was found. No clear relationship between the presence of debris captured by the filter device and new lesions detected by DWI was found (P = .087; odds ratio 3.067).


CONCLUSIONS
Neuroprotected carotid artery stent placement will not avoid silent cerebral ischemia. Systematic microscopic analysis of debris captured by the filter device has no predictive value for potential cerebral ischemia after carotid artery stent placement.
Maleux
G
G
Center for Vascular Diseases, Section of Interventional Radiology, University Hospitals Gasthuisberg, Leuven, Belgium. geert.maleux@uz.kuleuven.ac.be
Demaerel
P
P
Verbeken
E
E
Daenens
K
K
Heye
S
S
Van Sonhoven
F
F
Nevelsteen
A
A
Wilms
G
G
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000628:therapy; D002545:Brain Ischemia / Q000175:diagnosis* / Q000517:prevention & control; D017536:Carotid Artery, Common; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005337:Fibrin / Q000648:ultrastructure; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011140:Polyurethanes; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents
D008567:Membranes, Artificial; D011140:Polyurethanes; D005337:Fibrin