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AJNR - American Journal of Neuroradiology

Published ahead of print on December 7, 2007
doi: 10.3174/ajnr.A0871

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American Journal of Neuroradiology 29:608-612, March 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

A. Kastrup^a,b, K. Gröschel^a,b, T. Nägele^c, A. Riecker^d, F. Schmidt^b, S. Schnaudigel^a and U. Ernemann^c

^a Department of Neurology, University of Göttingen, Göttingen, Germany
^b Department of General Neurology, Center of Neurology and Hertie, Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
^c Department of Neuroradiology, University of Tübingen, Tübingen, Germany
^d Department of Neurology, University of Ulm, Ulm, Germany

Please address correspondence to Andreas Kastrup, Department of Neurology, University of Göttingen, Robert-Koch-Str 40, 37075 Göttingen, Germany; e-mail: andreas.kastrup{at}medizin.uni-goettingen.de

BACKGROUND AND PURPOSE: The routine use of distal filter devices during carotid angioplasty and stent placement (CAS) is controversial. The aim of this study was to analyze their effects on the incidence of new diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke in important subgroups.

materials and METHODS: DWI was performed immediately before and after CAS in 68 patients with and 175 without protection, and patients were further subdivided according to their age or symptom status.

RESULTS: The proportion of patients with new ipsilateral DWI lesion(s) was significantly lower after protected versus unprotected CAS (52% versus 68%), as well as in symptomatic patients (56% versus 74%) or those at or younger than 75 years of age (46% versus 67%; all P < .05). Similarly, the total number of lesions was significantly lower after protected versus unprotected CAS (median, 1; interquartile range [IQR], 0–2; versus median, 1; IQR 0–4.75) and in symptomatic patients (median, 1; IQR, 0–3; versus median, 2; IQR, 0–6) or those at or younger than 75 years of age (median, 0; IQR, 0–2; versus median, 1; IQR, 0–4; all P < .05). In contrast, for asymptomatic patients (48% versus 52%; P = .8; median, 0; IQR, 0–2; versus median, 1; IQR, 0–2.5; P = .6) or those older than 75 years of age (73% versus 69%; P = .7; median, 1; IQR, 0–4; versus median, 1.5; IQR, 0–5.75; P = .6), the proportion of patients with new lesion(s) and the total number of these lesions were not significantly different between protected and unprotected CAS.

CONCLUSIONS: The use of distal filter devices generally reduces the incidence of new DWI lesions; however, this beneficial effect might not necessarily pertain to older and asymptomatic patients.

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				H.J. Cloft Distal Protection: Maybe Less Than You Think AJNR Am. J. Neuroradiol., March 1, 2008; 29(3): 407 - 408. [Full Text] [PDF]