Periprocedural embolic events related to carotid artery stenting detected by diffusion-weighted MRI: comparison between proximal and distal embolus protection devices

El-Koussy, Marwan; Schroth, Gerhard; Do, Dai-Do; Gralla, Jan; Nedeltchev, Krassen; von Bredow, Ferdinand; Remonda, Luca; Brekenfeld, Caspar (2007). Periprocedural embolic events related to carotid artery stenting detected by diffusion-weighted MRI: comparison between proximal and distal embolus protection devices. Journal of endovascular therapy, 14(3), pp. 293-303. Phoenix, Ariz.: International Society of Endovascular Specialists 10.1583/06-1990.1

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PURPOSE: To evaluate and compare the efficacy of proximal versus distal embolus protection devices (EPD) during carotid artery angioplasty/stenting (CAS) based on diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: Forty-four patients (31 men; mean age 68 years, range 48-85) underwent protected CAS and had DW-MRI before and after the intervention. The cohort was analyzed according to the type of EPD used: a proximal EPD was deployed in 25 (56.8%) patients (17 men; mean age 66 years, range 48-85) and a distal filter in 19 (14 men; mean age 70 years, range 58-79). Fifteen (60.0%) patients with proximal protection were symptomatic of the target lesion; in the distal protection group, 10 (52.6%) were symptomatic. RESULTS: New lesions were seen on the postinterventional DW-MRI in 28.0% (7/25) of the proximal EPD group versus 32.6% (6/19) of those with a distal filter (p = NS). The majority were clinically silent. The new lesions in the vascular territory of the stented carotid artery in the group as a whole and per patient were fewer in the proximal EPD group (p = NS). No significant differences were noted in the T(2) appearance of the new lesions or the number of new lesions observed away from the vascular territory of the stented artery. CONCLUSION: Proximal embolus protection devices show a nonsignificant trend toward fewer embolic events, which warrants large-scale studies. Furthermore, proximal protection devices can be useful to control and treat acute in-stent thrombosis.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
UniBE Contributor:	El-Koussy, Marwan, Schroth, Gerhard, Do, Dai-Do, Gralla, Jan, von Bredow, Ferdinand, Remonda, Luca, Brekenfeld, Caspar
ISSN:	1526-6028
ISBN:	17723007
Publisher:	International Society of Endovascular Specialists
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:58
Last Modified:	05 Dec 2022 14:18
Publisher DOI:	10.1583/06-1990.1
PubMed ID:	17723007
Web of Science ID:	000247919700004
URI:	https://boris.unibe.ch/id/eprint/25094 (FactScience: 55345)