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Microembolization During Carotid Artery Stenting in Patients With High-Risk, Lipid-Rich Plaque: A Randomized Trial of Proximal Versus Distal Cerebral Protection Full Text
JACC - Journal of the American College of Cardiology, 10/14/2011
Montorsi P et al. – In patients with high–risk, lipid–rich plaque undergoing carotid artery stenting (CAS), MO.MA led to significantly lower microembolization as assessed by using MES counts.
Methods- 53 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
- Lesion wiring;
- Pre–dilation;
- Stent crossing;
- Stent deployment;
- Stent dilation;
- And device retrieval/deflation.
- Diffusion–weighted magnetic resonance imaging was conducted before CAS, after 48 h, and after 30 days.
- 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%).
