Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

• Published in: Neurologia medico-chirurgica Vol. 49; no. 9; pp. 386 - 393
• Main Authors: TAHA, Mahmoud M., MAEDA, Masayuki, SAKAIDA, Hiroshi, KAWAGUCHI, Kenji, TOMA, Naoki, YAMAMOTO, Akitaka, HIROSE, Tomofumi, MIURA, Youichi, FUJIMOTO, Masashi, MATSUSHIMA, Satoshi, TAKI, Waro
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2009
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - statistics & numerical data; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Brain - blood supply; Brain - pathology; Brain Ischemia - diagnosis; Brain Ischemia - physiopathology; Brain Ischemia - prevention & control; carotid artery stenting; Carotid Stenosis - surgery; Diffusion Magnetic Resonance Imaging - methods; diffusion-weighted magnetic resonance imaging; distal ischemia; Female; Filtration - instrumentation; Humans; Incidence; Intracranial Embolism - diagnosis; Intracranial Embolism - epidemiology; Intracranial Embolism - prevention & control; Male; Middle Aged; neuroprotection; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prostheses and Implants - statistics & numerical data; Prosthesis Design - instrumentation; Stents - adverse effects; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - instrumentation
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.49.386

Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusion-weighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm3 vs. 86.9 mm3, respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm3) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm3 and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.