title: Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.
abstract: OBJECTIVE
  To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI).
  
  
  METHODS
  We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA).
  
  
  RESULTS
  Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000).
  
  
  CONCLUSIONS
  We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection.
authors.affiliation: Ankara Numune Training and Research Hospital, Neurology Clinic, Ankara, Turkey.|Zeenat Qureshi Stroke Institute, St Cloud, Minnesota, USA.
authors.forename: Emrah
authors.identifier: http://orcid.org/0000-0001-8404-7049
authors.initials: E
authors.lastname: Aytac
authors.affiliation: Ankara Numune Training and Research Hospital, Neurology Clinic, Ankara, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Gürkaş
authors.affiliation: Ankara Numune Training and Research Hospital, Neurology Clinic, Ankara, Turkey.
authors.forename: Cetin Kursad
authors.initials: CK
authors.lastname: Akpinar
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota, USA.
authors.forename: Muhammad A
authors.identifier: http://orcid.org/0000-0001-5110-2806
authors.initials: MA
authors.lastname: Saleem
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota, USA.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000639:trends; D021721:Balloon Occlusion / Q000379:methods / Q000639:trends; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D057505:Embolic Protection Devices / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects / Q000639:trends; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D016896:Treatment Outcome
keywords: Angioplasty; Stenosis; Stent; Stroke; Technique