title: Significance of blood aspiration in carotid artery stenting with Angioguard XP.
abstract: OBJECTIVE
  In some patients, angiographic flow impairment is observed during carotid artery stenting (CAS) using Angioguard XP (AGXP), resulting in neurological symptoms. CAS was thus modified to improve clinical outcome.
  
  
  METHODS
  Ninety-seven patients were treated with CAS using AGXP from January 2008 to October 2009. In period I (January-December 2008; n = 53), blood aspirations were performed only in no-flow cases. In period II (January-October 2009; n = 44), blood aspirations were performed in no-flow and slow-flow cases. Clinical outcome, detection of microembolic lesions on diffusion-weighted imaging (DWI) and flow impairment during CAS were examined between these two periods before and after modifying the CAS procedure.
  
  
  RESULTS
  Periprocedural transient ischemic attacks occurred in 10 patients (18.9%) and one patient (2.27%) in periods I and II, respectively (P = .018). Minor and major strokes were observed in two patients in each period (P = .849). New ipsilateral DWI lesions were detected in 25 patients (47.2%) and 11 patients (25.0%) in periods I and II, respectively (P = .024). Among 18 slow-flow cases, new DWI lesions were detected in one patient (9.09%) and five patients (71.4%) with (n = 11) and without (n = 7) blood aspirations, respectively (P = .013). Neurological symptoms were observed only in three of seven patients (42.9%) without aspirations, compared to one of 11 patients (9.1%) with aspirations (P = .043).
  
  
  CONCLUSIONS
  Postoperative symptomatic stroke and new DWI lesions are significantly associated with blood flow impairment during CAS using AGXP. When flow impairment occurs, blood aspiration should be performed.
authors.affiliation: Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan. t_mizobe117@ybb.ne.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizobe
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Motooka
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Uchihashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sugihara
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D004617:Embolism / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*