Advancements in the Mo.Ma system procedure during carotid artery stenting.
OBJECTIVE
The aim of this paper was to reduce the incidence of clamping intolerance, asystolia, immediate mortality and neurological complications associated with carotid artery stenting (CAS) using the Mo.Ma system (Invatec, Roncadelle Brescia, Italy) embolic protection device (EPD).


METHODS
CAS was perfomed using the Mo.Ma system in 312 patients between January 2002-October 2009. From October 2008 variations to the standard technique were introduced. A total of 214 patients were treated with the standard technique, and 88 with the new technique. Improvements include the engagement of the guidewire's floppy tip through the lesion whilst the cerebral blood flow is maintained, a slow release post-dilation (1 atm/2 s), a quicker manual aspiration procedure following post-dilation, a redirection of blood flow into the external carotid artery (ECA) with the post-dilation balloon inflated in the internal carotid artery (ICA), and a further manual aspiration and the subsequent release of the Mo.Ma system.


RESULTS
This study reports reduced incidence of clamping intolerance (7.9% vs. 4.5%), asystolia (0 vs. 1.9%), immediate mortality (0 vs. 0.9%) and neurological complications (1.1% vs. 3.7%). The only neurological complication associated with the new technique was a transient ischemic attack (TIA).


CONCLUSIONS
The new variations of the standard Mo.Ma technique seem rational in the improvement of the safety and efficacy of CAS using an EPD, in reducing the incidence of clamping intolerance and asystolia, immediate mortality and neurological complications. This series indicates a positive trend for this revised technique, but a multicentre registry is required to validate these promising results.
Coppi
G
G
Department of Vascular Surgery, University of Modena and Reggio Emilia, Policlinic of Modena Nuovo Ospedale S. Agostino Estense, Modena, Italy. g.coppi@ausl.mo.it
Moratto
R
R
Silingardi
R
R
Veronesi
J
J
Nicolosi
E
E
Chester
J
J
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017130:Angioplasty / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex