Abstract
Background & objective: We evaluated the differences of the clinical deteriorations, distal migration of emboli, and approximation of stent to vessel between the patients who received distal or proximal protections to prevent distal migration of emboli during carotid artery stent interventions (CAS). Methods: We retrospectively analyzed clinical and radiological data of 70 patients (Distal-Protection Group), who underwent CAS using distal protection (FilterWire EZ TM , Boston Scientific), and 65 patients (Proximal-Protection Group), who using proximal protection (MO.MA® Ultra, Medtronic). The frequency of transient ischemic attacks (TIA) during CAS, the number and frequency of new lesions on post-CAS diffusion weighted image (DWI), and the ratio of the remained-area from outer stent wall to inner vessel wall measured by post-CAS carotid sonogrphy was compared between two groups. Results: Proximal-Protection Group showed significantly higher TIA occurrences during CAS (Distal-, 5 [7%]; Proximal- Protection Group, 19 patients [31%], p<0.001). On post-CAS DWI evaluation, total number (Distal-, 4.8±4.6; Proximal-Protection Group, 4.3±5.6, p=0.712) and incidence (Distal-, 29 [40%]; Proximal-Protection Group, 18 patients [29%], p=0.207) of the new DWI lesions were similar between the two groups. Major infarctions (Distal-, 5 [7%]; Proximal-Protection Group, 2 patients [3%], p=0.278) observed on ipsilateral cortex or internal borderzone area were more frequent on Distal- than Proximal-Protection Group without statistical significance. Both groups showed similar ratio of the remained-area from stent to vessel on post-CAS sonography (Distal, 0.33±0.18; Proximal-Protection Group, 0.28±0.15, p=0.072). Conclusions: The present differences in clinical and radiological parameters between different protection methods should be the factors to choose appropriate protection device during CAS.
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