title: Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting.
abstract: OBJECTIVE
  The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device.
  
  
  METHODS
  From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates.
  
  
  RESULTS
  CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group).
  
  
  CONCLUSIONS
  Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Jong Hyeok
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Hee Eon
authors.initials: HE
authors.lastname: Sohn
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Moon Sun
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Seong Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
authors.forename: Do Sung
authors.initials: DS
authors.lastname: Lee
keywords: Carotid stenosis; Cerebral infarction; Diffusion magnetic resonance; Embolic protection device