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

Kastrup, Andreas; Gröschel, Klaus; Nägele, Thomas; Riecker, Axel; Schmidt, Friederike; Schnaudigel, Sonja; Ernemann, Ulrike

doi:10.3174/ajnr.a0871

Cited by 39 publications

(11 citation statements)

References 33 publications

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“…The overall results and various subgroup analyses of this series have been reported previously [6,9,10]. …”

Section: Patient Populationmentioning

confidence: 80%

“…Using this imaging modality and the data of our prospective registry, we had recently analyzed the impact of cerebral protection devices, as well as the influence of advanced age on the incidence of new brain lesions after CAS [6,9,10]. The aims of this study were to determine angiographic and clinical risk factors for new DWI lesions after CAS in a first step and to subsequently generate a simple risk score by combining independent risk factors.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A risk score to predict ischemic lesions after protected carotid artery stenting

Gröschel

Ernemann

Schnaudigel

et al. 2008

Journal of the Neurological Sciences

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“…The overall results and various subgroup analyses of this series have been reported previously [6,9,10]. …”

Section: Patient Populationmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

A risk score to predict ischemic lesions after protected carotid artery stenting

Gröschel

Ernemann

Schnaudigel

et al. 2008

Journal of the Neurological Sciences

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“…However, these series compare protected series with historical controls which encompass considerable variation in presenting symptoms and age and overlook important technical advances such as dedicated carotid stents, fine guidewire technology, improvements in periprocedural pharmacological support and, of course, learning curve [2,3]. Kastrup et al [22] demonstrated that age and symptom status influenced the incidence of lesions on DWI following CAS.…”

Section: Discussionmentioning

confidence: 99%

Filter-Protected versus Unprotected Carotid Artery Stenting: A Randomised Trial

Macdonald

Evans

Griffiths³

et al. 2010

Cerebrovasc Dis

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Background: Our aim was to determine whether filter protection reduces embolisation to the brain during carotid artery stenting (CAS). Methods: Thirty patients with symptomatic carotid artery stenosis ≧70% (North American Symptomatic Carotid Endarterectomy Trial) were randomly assigned to filter-protected or unprotected CAS. Diffusion-weighted magnetic resonance imaging (DWI) of the brain was performed before and at 3 time points after CAS. In a subset of patients, high-intensity transient signals on transcranial Doppler (TCD) were recorded with categorisation of emboli. Data were independently reviewed off-site. Results: There were no significant differences in mean age, proportion of octogenarians or presenting symptoms between the groups. On procedural DWI (1–3 and 24 h after stenting), there were 7/24 (29%) and 4/22 (18%) new lesions in protected and unprotected patients respectively (p = 0.38). At 30 days there were 9/33 (26%) and 4/33 (12%) lesions in protected and unprotected patients, respectively (p = 0.1). On TCD there were significantly more signals in total as well as particulate emboli during filter-protected CAS (426.5 and 251.3) than during unprotected CAS (165.2 and 92) – p = 0.01 and 0.03, respectively. Conclusions: Filter-protected CAS is associated with an increase in new lesions on DWI and significantly higher rates of total and particulate microembolisation on TCD than unprotected CAS. The clinical significance of these findings requires further study.

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“…3,18–21) Theoretically, due to its larger pore size, the Spider FX may have a lower capture efficiency and may elicit more embolic complications than other eccentric filter EPDs. 22) The different capacity of each filter may also affect distal debris migration between the filter and vessel wall.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Flow Impairment during Carotid Artery Stenting Using Two Types of Eccentric Filter Embolic Protection Devices

Nii

Tsutsumi

Maeda

et al. 2016

Neurol. Med. Chir.(Tokyo)

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We investigated the angiographic findings and the clinical outcomes after carotid artery stenting (CAS) using two different, eccentric filter embolic protection devices (EPDs). Between July 2010 and August 2015, 175 CAS procedures were performed using a self-expandable closed-cell stent and a simple eccentric filter EPD (FilterWire EZ in 86 and Spider FX in 89 procedures). The angiographic findings (i.e., flow impairment and vasospasm) at the level of EPDs, neurologic events, and post-operative imaging results were compared between the FilterWire EZ and the Spider FX groups. The CAS was angiographically successful in all 175 procedures. However, the angiographs were obtained immediately after CAS-detected flow impairment in the distal internal carotid artery (ICA) in 11 (6.3%) and ICA spasms at the level of the EPD in 40 cases (22.9%). The incidence of these complications was higher with FilterWire EZ than Spider FX (ICA flow impairment of 10.5% vs. 2.2%, P = 0.03; vasospasm 30.2% vs. 15.7%, P = 0.03). There were nine neurologic events (5.1%); five patients were presented with transient ischemic attacks, three had minor strokes, and one had a major stroke. New MRI lesions were seen in 25 (29.1%) FilterWire-group and in 36 (40.4%) Spider-group patients. The neurologic events and new MRI lesions were not associated with the type of EPD used. Although the ICA flow impairment may result in neurologic events, there was no significant association between the FilterWire EZ and the Spider FX CAS with respect to the incidence of neurologic events by the prompt treatment such as catheter aspiration.

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

Cited by 39 publications

References 33 publications

A risk score to predict ischemic lesions after protected carotid artery stenting

A risk score to predict ischemic lesions after protected carotid artery stenting

Filter-Protected versus Unprotected Carotid Artery Stenting: A Randomised Trial

Comparison of Flow Impairment during Carotid Artery Stenting Using Two Types of Eccentric Filter Embolic Protection Devices

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