• Myung Sub Kim, Myung Ho Rho, Hyun Pyo Hong, Hee Jin Park, Pil Wook Chung, and Yu Sam Won.
• Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
• World Neurosurg. 2020 Mar 1; 135: e731-e737.

ObjectiveTwo main types of embolic protection devices have been used during carotid artery stenting (CAS): distal protection devices (DPDs) and proximal protection devices (PPDs). We compared the complications, clinical outcomes, and new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) studies between patients who had undergone CAS using a DPD or PPD.MethodsWe performed a retrospective review of the data from patients who had undergone CAS from March 2010 to January 2016. The periprocedural and 30-day adverse events and new ischemic lesions on DWI studies after CAS were evaluated.ResultsCAS was performed in 103 patients (DPD, n = 60; PPD, n = 43). The number of patients with new ischemic lesions was greater in the DPD than in the PPD group (78% vs. 56%; P = 0.014). Most lesions (>90%) were tiny (≤3 mm), and the average number of new tiny lesions per patient was significantly greater in the DPD than in the PPD group (mean, 9.6 vs. 4.0; P = 0.008). No significant differences in the periprocedural or 30-day adverse rates were noted between the 2 groups. Intolerance during the procedure occurred in 5 patients (12%) in the PPD group, 4 of whom had poor collateral circulation.ConclusionsThe number of new ischemic lesions per patient and the incidence of ischemic lesions found on DWI were significantly greater in the DPD than in the PPD group. The lack of differences in the periprocedural and 30-day adverse rates between the 2 groups suggests that cerebral microemboli might not be associated with the clinical outcomes. For patients with poor collateral status, DPDs should be used preferentially to avoid the neurologic compromise associated with PPDs.Copyright © 2020 Elsevier Inc. All rights reserved.

19 keywords...

hide…