Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting

  • Lee, Jong Hyeok (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Sohn, Hee Eon (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Chung, Seung Young (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Park, Moon Sun (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Kim, Seong Min (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University) ;
  • Lee, Do Sung (Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University)
  • Received : 2015.06.12
  • Accepted : 2015.09.23
  • Published : 2015.10.28
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Abstract

Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

Keywords

References

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