American Journal of Neuroradiology 27:1830-1833, October 2006
© 2006 American Society of Neuroradiology
INTERVENTIONAL
Cerebral Ischemia after Filter-Protected Carotid Artery Stenting Is Common and Cannot Be Predicted by the Presence of Substantial Amount of Debris Captured by the Filter Device
a Center for Vascular Diseases, Section of Interventional Radiology, University Hospitals Gasthuisberg, Leuven, Belgium
b Center for Vascular Diseases, Section of Vascular Surgery, University Hospitals Gasthuisberg, Leuven, Belgium
c Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium
d Department of Pathology, University Hospitals Gasthuisberg, Leuven, Belgium
Address correspondence to Geert Maleux, MD, Center for Vascular Diseases, Section of Interventional Radiology, Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium; e-mail: geert.maleux{at}uz.kuleuven.ac.be
PURPOSE: Protected carotid artery stent placement is currently under clinical evaluation as a potential alternative to carotid endarterectomy. The current study was undertaken to determine the incidence of new ischemic lesions found on diffusion-weighted MR imaging (DWI) in nonselected patients after protected carotid artery stent placement using a filter device and to determine the potential relationship between these new ischemic lesions and the presence or absence of a clear amount of debris captured by the neuroprotection filter device.
MATERIALS AND METHODS: A nonrandomized cohort of 52 patients (40 men, 12 women) presenting with carotid occlusive disease underwent protected carotid artery stent placement using a filter device. DWI obtained 1 day before stent placement was compared with that obtained 1 day after stent placement. In addition, the macroscopic and microscopic analysis of debris captured by the filter device during the carotid stent placement procedure was assessed.
RESULTS: Neuroprotected carotid stent placement was technically successful in all 53 procedures but was complicated by a transient ischemic attack in 3 patients (5.6%). In 22 patients (41.5%), new ischemic lesions were found on DWI, and in 21 filter devices (39.6%), a substantial amount of atheromatous plaque and/or fibrin was found. No clear relationship between the presence of debris captured by the filter device and new lesions detected by DWI was found (P = .087; odds ratio 3.067).
CONCLUSION: Neuroprotected carotid artery stent placement will not avoid silent cerebral ischemia. Systematic microscopic analysis of debris captured by the filter device has no predictive value for potential cerebral ischemia after carotid artery stent placement.
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