Cerebral ischemic lesions detected with diffusion-weighted magnetic resonance imaging after carotid artery stenting: Comparison of several anti-embolic protection devices.
Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusion-weighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm(3) vs. 86.9 mm(3), respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm(3)) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm(3) and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.
Department of Neurosurgery, Mie University School of Medicine, Tsu, Mie.
Mahmoud M
MM
Taha
Masayuki
M
Maeda
Hiroshi
H
Sakaida
Kenji
K
Kawaguchi
Naoki
N
Toma
Akitaka
A
Yamamoto
Tomofumi
T
Hirose
Youichi
Y
Miura
Masashi
M
Fujimoto
Satoshi
S
Matsushima
Waro
W
Taki
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D011474:Prosthesis Design / Q000295:instrumentation; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation