Introduction: We routinely used ballon-type emboli-protection devices (EPDs) during carotid artery stenting (CAS) in the first period, and filter-type EPDs in the second period. Currently, we decide to select from various kinds of EPDs according to MR imaging of carotid plaque in the third period.
Methods: We reviewed the clinical outcomes of 115 patients who underwent CAS with an emboli-protection device for 126 hemispheres/arteries (62 asymptomatic lesions and 64 symptomatic lesions). Ninty three patients were male and 22 were female. The median age was 72 years (range 50–96 years). Carotid wall MRI was performed preoperatively in 32 patients (29%), and the signal intensity of the plaque on T1-weighted images was determined. An EPD was decided based on the signal intensity of the plaque compared with sternocleidomastoid muscle and the plaque volume. We treated 65, 29, and 32 lesions in the 1st, 2nd , and 3rd period, respectively. Overall, we used 65 balloon-type EPDs, 42 filter-type EPDs, and 17 flow-reversal EPDs.
Results: The technical successful rate was 99.2%. Perioperative stroke was observed in six patients (5 ischemic strokes and a hemorrhagic stroke). The 30-day TIA rate was 7.1% and the stroke rate was 4.8%; no patients died during this period. Two strokes were observed in each period; six TIAs were observed in the 1st period, and a TIA was observed in the 3rd period. Three of six (50%) strokes, and six of seven (86%) TIAs were due to distal emboli. The 30-day TIA or stroke rate only due to distal emboli was 9.2%, 6.9%, and 3.1% in the 1st, 2nd, and 3rd period, respectively.
Conclusions: Perioperative TIAs and strokes due to distal emboli can be minimized when we select an EPD based on MR imaging of the carotid plaque.
Patient Care: The data showed that selection of emboli protection device in our approach can minimize perioperative stroke due to distal emboli.
Learning Objectives: How to select emboli protection device to lessen perioperative stroke due to distal emboli in carotid artery stenting.
References: #1 Stabile et al. J Am Coll Cardiol 2010;55:1661–7
#2 Piotr Pieniazek et al. Kardiol Pol 2012; 70, 4: 378–386
#3 Tanemura et al. Stroke 44, 105-110, 2013