• Seung Kug Baik, Ungbae Jeon, Ki Seok Choo, Yong-Woo Kim, and Kyung Pil-Park.
• Department of Diagnostic Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. skbaik9@gmail.com
• Neurosurgery. 2011 Apr 1; 68 (4): 1084-90; discussion 1091.

BackgroundThere is a theoretical concern that a thrombus may be dislodged distally when crossing the occluded segment during recanalization of a complete occlusion.ObjectiveTo assess the immediate postprocedural brain diffusion-weighted image (DWI) findings following endovascular recanalization using an embolic protection device for proximal internal carotid artery (ICA) occlusion.Materials And MethodsWe retrospectively identified 12 patients who underwent stent implantation for sudden symptomatic occlusion of the proximal ICA. In 8 patients, no additional intracranial occlusions were identified. In 4 patients, an additional intracerebral thrombus was detected in the middle cerebral artery. Distal protection devices were used in all cases. We evaluated the presence and amount of retrieved embolic fragments in the distal protection devices. The incidence and location of postprocedural emboli were determined using DWI.ResultsRecanalization of the proximal ICA was achieved in all patients. After complete occlusion of the proximal ICA was demonstrated, primary passage of the embolic protection device through the occluded ICA was gently navigated in 7 patients. However, this was not possible in 5 patients. Three patients developed new lesions on postprocedural DWI. Of the 12 patients in which distal protection devices were used, debris was detected in 7 patients.ConclusionIn endovascular revascularization of proximal ICA occlusion, postprocedural emboli occur less frequently than reported in a systematic review of the DWI literature. The real risk of dislodging thrombi appears to be from plaque fragment mobilization by angioplasty, rather than from crossing an occluded segment.

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