Cerebral Embolic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging Following Carotid Artery Stenting

Abstract

Our meta-analysis supports the concept that the use of proximal balloon occlusion compared with filter cerebral protection is associated with a reduction of the amount of CAS-related brain embolization. The data should be confirmed by a randomized clinical trial.

Carotid Artery Stenting With Proximal Embolic Protection via a Transradial or Transbrachial Approach

“…[19][20][21][22] Despite anecdotal cases and small series reporting favorable results of TR CAS with proximal protection, 13,14 this technique has not gained widespread acceptance yet, likely because the size (8-F) and stiffness of the proximal protection device make radial access and navigation in the complex anatomy of the supra-aortic vessels difficult. The best indicator of feasibility of TR CAS is the rate of crossover to a transfemoral approach, mainly due to difficulties in target vessel engagement.…”

Preoperative and Postoperative Evaluation of New Double Mesh Carotid Stents with Contrast-Enhanced Ultrasound and Diffusion-Weighted Imaging

“…8 In particular, some studies correlate the presence of early microembolizations after CAS with late cognitive decline, even if in a recent review controversial considerations do not clarify the real impact on cognitive functions. 10 To reduce the risk of intraoperative embolizations, 2 novel innovations are still matter of research: new types of embolic protection devices, such as proximal balloon occlusion, 11 and new stent designs. reviewed a multicentre case series of CAS procedures and found an overall significant higher rate of postprocedural neurological events with opencells stents, even if no statistical differences were detected in asymptomatic patients.…”

Commentary: Carotid Artery Revascularization for Stroke Prevention

“…[57][58][59] According to "tailored CAS" algorithms, 11,53,60 proximal neuroprotection is preferred in endovascular management of symptomatic and high-risk asymptomatic lesions. The use of ultra-closed-cell stent systems (achieved by covering the nitinol frame with a mesh made of different materials), on the other hand, not only further reduces the risk of intraprocedural neurologic complications but also, by preventing plaque protrusion through stent struts, eliminates postprocedural cerebral embolization as manifested on routine diffusion-weighted magnetic resonance imaging (DW-MRI).…”

“…Therefore, cerebral DW-MRI imaging is going to continue to provide a sensitive surrogate in the evaluation of novel carotid revascularization technologies and treatment strategies. 48,56,57,59,61,68,69 One obvious question would be whether different sizes of mesh pores are associated with any differences in embolic prevention efficacy as per the number and size of DW-MRI cerebral lesions. 67 However, a number of other important factors of DW-MRI cerebral lesions, such as the plaque type and procedural strategy (eg, proximal vs distal neuroprotection) need to be taken into consideration in any direct or indirect comparative analyses of dual-layered stents.…”