title: Carotid artery stenting performed with a flow-reversal technique: improved technical performance.
abstract: OBJECTIVE
  To report our experience in carotid artery stenting (CAS) with GORE flow reversal system, focusing the assessment of its efficacy, security and practice procedure evolution.
  
  
  METHODS
  Twelve patients treated for atherosclerotic carotid stenosis were prospectively evaluated. All patients were symptomatic. Carotid symptoms were embolic stroke in eight, watershed stroke in two and transient ischemic attack (TIA) in two patients. All patients underwent carotid ultrasound, brain magnetic resonance image and magnetic resonance angiography before CAS procedure. The procedure time and the flow reversal time were registered. Neurological outcome was evaluated before treatment, during the first 48 hours post-treatment and after 3 months.
  
  
  RESULTS
  CAS was successful in all cases. Mean procedure time was 33.8 minutes. Mean flow reversal time was 7.3 minutes. Temporary bradycardia occurred with six patients without associated hemodynamic instability. NIHSS patients' scores ranged from 0 to 5 (average 1.1) on admission and remained unchanged during 48 hours after treatment. mRS patients' scores ranged from 0 to 3 (average 1.6) on admission and remained unchanged during the follow-up of 3 months. There were no complications concerning groin puncture, or general anesthesia, or myocardial infarct or death.
  
  
  CONCLUSIONS
  In our present selected subjects, the CAS procedure using the GORE flow reversal system appeared to be safe and effective, with improved technical performance of the procedure. This was observed in particular with the flow-reversal times achieved. Thus, studies comparing the GORE system and other protection devices are suggested to ascertain all of the benefits of flow reversal during CAS.
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: de Castro-Afonso
authors.forename: Lívia
authors.initials: L
authors.lastname: de Oliveira
authors.forename: Octávio Marques
authors.initials: OM
authors.lastname: Pontes-Neto
authors.forename: Soraia Ramos Cabette
authors.initials: SR
authors.lastname: Fábio
authors.forename: Eduardo
authors.initials: E
authors.lastname: Wajnberg
authors.forename: Daniel Giansante
authors.initials: DG
authors.lastname: Abud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D057505:Embolic Protection Devices; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome