Objectives: The goal of this study was to compare the rate of cerebral microembolization during carotid artery stenting (CAS) with proximal versus distal cerebral protection in patients with high-risk, lipid-rich plaque. Background: Cerebral protection with filters partially reduces the cerebral embolization rate during CAS. Proximal protection has been introduced to further decrease embolization risk. Methods: Fifty-three consecutive patients with carotid artery stenosis and lipid-rich plaque were randomized to undergo CAS with proximal protection (MO.MA system, n = 26) or distal protection with a filter (FilterWire EZ, n = 27). Microembolic signals (MES) were assessed by using transcranial Doppler during: 1) lesion wiring; 2) pre-dilation; 3) stent crossing; 4) stent deployment; 5) stent dilation; and 6) device retrieval/deflation. Diffusion-weighted magnetic resonance imaging was conducted before CAS, after 48 h, and after 30 days. Results: Patients in the MO.MA group had higher percentage diameter stenosis (89 ± 6% vs. 86 ± 5%, p = 0.027) and rate of ulcerated plaque (35% vs. 7.4%; p = 0.019). Compared with use of the FilterWire EZ, MO.MA significantly reduced mean MES counts (p < 0.0001) during lesion crossing (mean 18 [interquartile range (IQR): 11 to 30] vs. 2 [IQR: 0 to 4]), stent crossing (23 [IQR: 11 to 34] vs. 0 [IQR: 0 to 1]), stent deployment (30 [IQR: 9 to 35] vs. 0 [IQR: 0 to 1]), stent dilation (16 [IQR: 8 to 30] vs. 0 [IQR: 0 to 1]), and total MES (93 [IQR: 59 to 136] vs. 16 [IQR: 7 to 36]). The number of patients with MES was higher with the FilterWire EZ versus MO.MA in phases 3 to 5 (100% vs. 27%; p < 0.0001). By multivariate analysis, the type of brain protection was the only independent predictor of total MES number. No significant difference was found in the number of patients with new post-CAS embolic lesion in the MO.MA group (2 of 14, 14%) as compared with the FilterWire EZ group (9 of 21, 42.8%). Conclusions: In patients with high-risk, lipid-rich plaque undergoing CAS, MO.MA led to significantly lower microembolization as assessed by using MES counts. (Carotid Stenting in Patients With High Risk Carotid Stenosis ["Soft Plaque"] [MOMA]; NCT01274676) © 2011 American College of Cardiology Foundation.
Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque: A randomized trial of proximal versus distal cerebral protection / P. Montorsi, L. Caputi, S. Galli, E. Ciceri, G. Ballerini, M. Agrifoglio, P. Ravagnani, D. Trabattoni, G. Pontone, F. Fabbiocchi, A. Loaldi, E. Parati, D. Andreini, F. Veglia, A.L. Bartorelli. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 0735-1097. - 58:16(2011 Oct), pp. 1656-1663.
|Titolo:||Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque: A randomized trial of proximal versus distal cerebral protection|
|Parole Chiave:||carotid stenting; cerebral embolization; embolic protection; Aged; Aged, 80 and over; Carotid Stenosis; Catheterization; Constriction, Pathologic; Coronary Angiography; Diffusion Magnetic Resonance Imaging; Female; Humans; Intracranial Embolism; Lipids; Magnetic Resonance Imaging; Male; Middle Aged; Risk; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Stents; Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
Settore MED/23 - Chirurgia Cardiaca
|Data di pubblicazione:||ott-2011|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.jacc.2011.07.015|
|Appare nelle tipologie:||01 - Articolo su periodico|