Cerebral ischemia detected with diffusion-weighted MR imaging after protected carotid artery stenting: comparison of distal balloon and filter device.
OBJECTIVE
The aim of this study was to examine the incidence of ischemia during protected carotid artery stenting (CAS) as well as to compare the protective efficacy of the balloon and filter devices on diffusion-weighted MR imaging (DWI).


METHODS
Seventy-one consecutive protected CAS procedures in 70 patients with a severe (> 70%) or symptomatic moderate (> 50%) carotid artery stenosis were examined. A balloon device (PercuSurge GuardWire) and a filter device (FilterWire EX/EZ, Emboshield) was used in 33 cases (CAS-B group) and 38 cases (CAS-F group) to prevent distal embolization, respectively. All the patients underwent DWI within seven days before and after the procedures. The number of new cerebral ischemic lesions on the post-procedural DWI were counted and divided into ipsilateral and contralateral lesions according to the relationship with the stenting side.


RESULTS
New cerebral ischemic lesions were detected in 13 (39.4%) out of the 33 CAS-Bs and in 15 (39.5%) out of the 38 CAS-Fs. The mean number of total, ipsilateral and contralateral new cerebral ischemic lesion was 2.39, 1.67 and 0.73 in the CAS-B group and 2.11, 1.32 and 0.79 in the CAS-F group, respectively. No statistical differences were found between the two groups (p = 0.96, 0.74 and 0.65, respectively). The embolic complications encountered included two retinal infarctions and one hemiparesis in the CAS-B group (9.09%), and one retinal infarction, one hemiparesis and one ataxia in the CAS-F group (7.89%). There was a similar incidence of embolic complications in the two groups (p = 1.00).


CONCLUSIONS
The type of distal protection device used such as a balloon and filter does not affect the incidence of cerebral embolization after protected CAS.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Suk Jung
SJ
Kim
Hong Gee
HG
Roh
Pyoung
P
Jeon
Keon Ha
KH
Kim
Kwang Ho
KH
Lee
Hong Sik
HS
Byun
Won Jin
WJ
Moon
Gyeong Moon
GM
Kim
Young Wook
YW
Kim
Dong Ik
DI
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002545:Brain Ischemia / Q000473:pathology*; D016893:Carotid Stenosis / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D015356:Retinal Artery Occlusion / Q000209:etiology; D012720:Severity of Illness Index; D015607:Stents