title: Carotid artery stenting with double cerebral embolic protection in asymptomatic patients - a diffusion-weighted MRI controlled study.
abstract: The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting.
  
  
  
  119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24-48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected.
  
  
  
  New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001).
  
  
  
  The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times. .
authors.affiliation: 1 Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
authors.forename: Ertan
authors.initials: E
authors.lastname: Vuruskan
authors.affiliation: 1 Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Saracoglu
authors.affiliation: 1 Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Ergun
authors.affiliation: 1 Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Poyraz
authors.affiliation: 1 Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
authors.forename: İrfan Veysel
authors.initials: İV
authors.lastname: Duzen
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
keywords: Cerebral protection; carotid; magnetic resonance imaging; stent