Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device
Jong Hyeok Lee1, Hee Eon Sohn1, Seung Young Chung1
1Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.
Insights
Proximal balloon occlusion devices may reduce cerebral embolisms during carotid artery stenting (CAS) compared to distal filter protection. This study found fewer new ischemic lesions with balloon occlusion, suggesting improved safety for CAS procedures.
Area of Science:
- Interventional Cardiology
- Neurology
- Vascular Surgery
Background:
- Cerebral embolus dislodgement is a primary risk during transfemoral carotid artery stenting (CAS).
- Effective embolic protection strategies are crucial for patient safety during CAS.
Purpose of the Study:
- To compare clinical outcomes and intraprocedural embolization rates of CAS using distal filter protection versus proximal balloon occlusion devices.
- To evaluate the efficacy of different embolic protection devices in preventing new ischemic lesions after CAS.
Main Methods:
- A single-center study included 58 patients with significant carotid artery stenosis undergoing CAS between January 2011 and March 2015.
- Patients were treated with either a distal filter protection device or a proximal balloon occlusion device.
- Post-procedural diffusion-weighted magnetic resonance imaging (DW-MRI) was used to detect new ischemic lesions.
Main Results:
- Both devices demonstrated high success rates (96.6% for filter, 93.8% for balloon).
- Proximal balloon occlusion resulted in significantly fewer new ischemic lesions per patient (p=0.028) compared to distal filter protection.
- Neurologic events were low in both groups, with only two events occurring in successfully treated patients.
Conclusions:
- Transfemoral CAS using a proximal balloon occlusion device yields favorable outcomes.
- Proximal balloon occlusion appears more effective than distal filter protection in minimizing cerebral embolism during CAS.
- Further research may confirm the superior safety profile of proximal balloon occlusion for CAS.
Objective:
The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device.
Methods:
From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates.
Results:
CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group).
Conclusion:
Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.
