Carotid stenting of asymptomatic and symptomatic carotid artery stenoses with and without the use of a distal embolic protection device.

OBJECTIVE

The objective of this study was to evaluate the incidence of symptomatic and clinically silent embolic following carotid angioplasty and stent placement (CAS) with and without the use of an embolic protection device (EPD).

MATERIALS AND METHODS

Between January 2006 and April 2009, 76 patients with carotid stenosis underwent 79 CAS procedures (three patients had bilateral CAS). In this group, 44 of the 79 procedures were performed with an EPD, and 35 were performed without an EPD. In the EPD group, 26 treated hemispheres received pre- and post-operative diffusion-weighted MRI (DWI), and in the non-EPD group, 16 treated hemispheres received pre- and post-operative DWI.

RESULTS

All 79 procedures were technically successful without significant residual stenosis. In the EPD group, there were three symptomatic ischaemic events (6.8%), and 4 of the 26 (15.4%) treated hemispheres which received MRI showed new DWI lesions. In the non-EPD group, there was one symptomatic ischaemic event (2.9%), one mortality (2.9%) due to reperfusion injury with intracranial haemorrhage, and three of the 16 (18.8%) treated hemispheres which received MRI showed new DWL lesions.

CONCLUSIONS

The results of this retrospective analysis do not show demonstrable benefits of reducing new DWI lesions or major/minor ischaemic events after CAS with a filter protection device. Further investigations with more accurate risk-analysis strategies remain necessary in hopes of selecting patients most likely to benefit from the use of an embolic protection device.