title: Transcranial Doppler and diffusion-weighted magnetic resonance evaluation of cerebral embolization occurring during transfemoral carotid stenting with proximal flow blockage.
abstract: BACKGROUND
  Transfemoral carotid artery stenting (CAS) with endovascular proximal flow blockage is deemed able to reduce the cerebral embolization observed during filter-protected CAS. We evaluated clinical outcome and intraoperative embolization rates, measured by diffusion-weighted magnetic resonance imaging (DW-MRI) and transcranial Doppler monitoring, in a series of patients undergoing CAS with proximal flow blockage.
  
  
  METHODS
  A series of 35 consecutive patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were included to undergo CAS with proximal flow blockage, obtained with the Mo.Ma system. All patients underwent preoperative and postoperative DW-MRI in order to detect new ischemic lesions. Of the 35 patients, 31 (89%) underwent intraoperative transcranial Doppler monitoring to record the microembolic signals (MES) produced during each procedure.
  
  
  RESULTS
  The MoMa system was successfully used in 34 patients (technical success: 97%). Intolerance to balloon occlusion was observed in 4 patients (12%), but never compromised the completion of the procedure. No deaths or neurological events occurred in the postoperative period. DW-MRI disclosed 74 new ischemic lesions in 8 patients (8/34, 23.5%). All lesions except one were ipsilateral to the treated carotid artery. MES were detected in all procedures, with a mean number of 33.2±23.2 (range 3-103). In 20 procedures (20/31, 65%), MES were detected also during flow blockage (mean: 9.1±7; range 2-28).
  
  
  CONCLUSIONS
  While achieving good technical and clinical results, CAS with proximal flow blockage is still accompanied by a non-negligible cerebral embolization. The detection of MES during ICA flow blockage suggests the need for a better selection of patients.
authors.affiliation: Vascular Surgery Unit, Sant'Andrea Hospital, La Sapienza University (Seconda Facoltà), Rome, Italy - giovanni.palombo@tiscali.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palombo
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Stella
authors.forename: Cristiano
authors.initials: C
authors.lastname: Fantozzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzao
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taurino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D016893:Carotid Stenosis / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D057505:Embolic Protection Devices; D005260:Female; D005263:Femoral Artery; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial