Carotid artery stenting with double cerebral embolic protection in asymptomatic patients-a diffusion weighted MRI controlled study

Abstract

Background: The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal fi lter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. Patients and methods: 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal fi lters (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 fi ndings were collected. Results: 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 fi lters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-fi lter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fl uoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). Conclusions: 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.