title: Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices.
abstract: OBJECTIVE
  Proximal cerebral protection devices have been developed as an alternative to filter protection devices for reducing neurological complications during carotid artery stenting (CAS). The aim of the present study was to evaluate the frequency of silent cerebral embolism after CAS using different cerebral embolic protection devices and the impact of silent cerebral embolism on neurocognitive function.
  
  
  METHODS
  One hundred consecutive patients who underwent CAS were enrolled. The patients were randomized to either proximal balloon occlusion or filter protection. Neurocognitive tests were performed before and six months after CAS. Cerebral embolisms were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI).
  
  
  RESULTS
  The number and volume of new ischemic lesions found with DW-MRI were higher in the filter protection group than in the proximal balloon occlusion group. According to our definition, nine (21%) patients in the balloon occlusion group and 16 (36%) patients in the filter protection group showed neurocognitive decline, and ten (23%) patients in the balloon occlusion group and four (9%) patients in the filter protection group showed neurocognitive improvement (NS). Regarding the group of patients with new cerebral ischemic lesions on DW-MRI, neurocognitive decline occurred in 14 (31%) of 45 patients with DW-MRI lesions and 11 (26%) of 43 patients without DW-MRI lesions (NS).
  
  
  CONCLUSIONS
  Neurocognitive outcome after CAS is unpredictable; both neurocognitive decline and improvement can occur. In this study, the proximal balloon occlusion system significantly decreased cerebral microemboli during CAS compared to filter protection. Cerebral microembolism was not found to be associated with neurocognitive decline.
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. Electronic address: dremreakkaya@hotmail.com.
authors.forename: Emre
authors.initials: E
authors.lastname: Akkaya
authors.affiliation: Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey.
authors.forename: Ertan
authors.initials: E
authors.lastname: Vuruskan
authors.affiliation: Department of Neurology, Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.
authors.forename: Zeynep Bastug
authors.initials: ZB
authors.lastname: Gul
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Pusuroglu
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Surgit
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ali Kemal
authors.initials: AK
authors.lastname: Kalkan
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Akgul
authors.affiliation: Department of Neurology, Gaziantep State Hospital, Gaziantep, Turkey.
authors.forename: Gamze Pinar
authors.initials: GP
authors.lastname: Akgul
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
mesh_terms: D000368:Aged; D017536:Carotid Artery, Common / Q000473:pathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D057505:Embolic Protection Devices / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015607:Stents / Q000639:trends*; D016896:Treatment Outcome
keywords: Carotid artery stenting; Cerebral microembolism; Neurocognitive function