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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

MONTORSI, Piero ; CAPUTI, Luigi ; LOALDI, Alessandro ; PARATI, Eugenio ; ANDREINI, Daniele ; VEGLIA, Fabrizio ; BARTORELLI, Antonio L ; GALLI, Stefano ; CICERI, Elisa ; BALLERINI, Giovanni ; AGRIFOGLIO, Marco ; RAVAGNANI, Paolo ; TRABATTONI, Daniela ; PONTONE, Gianluca ; FABBIOCCHI, Franco

Journal of the American College of Cardiology, 2011-10, Vol.58 (16), p.1656-1663 [Periódico revisado por pares]

New York, NY: Elsevier

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Título:
Microembolization During Carotid Artery Stenting in Patients With High-Risk, Lipid-Rich Plaque: A Randomized Trial of Proximal Versus Distal Cerebral Protection
Autor: MONTORSI, Piero ; CAPUTI, Luigi ; LOALDI, Alessandro ; PARATI, Eugenio ; ANDREINI, Daniele ; VEGLIA, Fabrizio ; BARTORELLI, Antonio L ; GALLI, Stefano ; CICERI, Elisa ; BALLERINI, Giovanni ; AGRIFOGLIO, Marco ; RAVAGNANI, Paolo ; TRABATTONI, Daniela ; PONTONE, Gianluca ; FABBIOCCHI, Franco
Assuntos: Aged ; Aged, 80 and over ; Angioplasty ; Biological and medical sciences ; Brain ; Cardiology ; Cardiology. Vascular system ; Cardiovascular disease ; Carotid artery ; Carotid Stenosis - surgery ; Catheterization - instrumentation ; Catheterization - methods ; Clinical trials ; Constriction, Pathologic ; Coronary Angiography - methods ; Coronary vessels ; Diffusion Magnetic Resonance Imaging - methods ; Diseases of the cardiovascular system ; Embolization ; Female ; Filters ; Flow velocity ; Heart attacks ; Humans ; Implants ; Intracranial Embolism - pathology ; Lipids ; Lipids - chemistry ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Multivariate analysis ; Patients ; Plaques ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk ; Risk factors ; Risk groups ; Stenosis ; Stents ; Time Factors ; Tomography ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography, Doppler - methods ; Ultrasound
É parte de: Journal of the American College of Cardiology, 2011-10, Vol.58 (16), p.1656-1663
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Descrição: 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. Cerebral protection with filters partially reduces the cerebral embolization rate during CAS. Proximal protection has been introduced to further decrease embolization risk. 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. 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%). In patients with high-risk, lipid-rich plaque undergoing CAS, MO.MA led to significantly lower microembolization as assessed by using MES counts.
Editor: New York, NY: Elsevier
Idioma: Inglês

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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

MONTORSI, Piero ; CAPUTI, Luigi ; LOALDI, Alessandro ; PARATI, Eugenio ; ANDREINI, Daniele ; VEGLIA, Fabrizio ; BARTORELLI, Antonio L ; GALLI, Stefano ; CICERI, Elisa ; BALLERINI, Giovanni ; AGRIFOGLIO, Marco ; RAVAGNANI, Paolo ; TRABATTONI, Daniela ; PONTONE, Gianluca ; FABBIOCCHI, Franco

New York, NY: Elsevier

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