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Double balloon protection during carotid artery stenting for vulnerable carotid stenosis reduces the incidence of new brain lesions.

Abstract：

BACKGROUND:The use of distal filter protection alone is associated with a high risk of ischemic complications when vulnerable carotid stenosis is treated by carotid artery stenting (CAS). Double balloon protection, a combination of distal balloon protection and proximal balloon occlusion, can be utilized. We assessed the outcome and complications of the double balloon protection method for vulnerable carotid stenosis. METHODS:Among 130 patients who underwent CAS from 2009 to 2014, we enrolled the following patients: those whose target lesion was vulnerable as evaluated by MRI, i.e., a signal ratio of plaque to posterior cervical muscle on T1-weighted images before CAS of ≥1.5, and those who underwent diffusion-weighted imaging (DWI) studies within 48 h after the procedure. Ninety patients were enrolled. We investigated DWI findings of the double balloon protection group compared with those of the simple distal balloon protection and distal filter protection groups. RESULTS:Sixty-four patients (71 %) underwent double balloon protection, 15 patients (17 %) simple distal balloon protection, and 11 patients (12 %) distal filter protection. Symptomatic embolic complications and new lesions on DWI after CAS were significantly less common in patients undergoing double balloon protection compared to distal balloon protection or distal filter protection (0 % vs. 20 %, 9 %, P < 0.01, and 30 % vs. 67 %, 82 %, P < 0.01, respectively). Logistic regression analysis also identified the odds ratio of double balloon protection for new lesions on DWI after CAS of 0.23 (95 % confidence interval: 0.07-0.70, P < 0.01) compared to simple distal protections. CONCLUSIONS:In the patients who underwent CAS for vulnerable carotid stenosis, double balloon protection was an independent significant factor associated with a reduction in the risk of new lesions on DWI after the procedure compared to conventional distal protections.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Nakazaki M,Nonaka T,Takahashi A,Yonemasu Y,Nomura T,Onda T,Honda O,Hashimoto Y,Ohnishi H,Sasaki M,Daibo M,Honmou O

doi

10.1007/s00701-016-2816-2

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

1377-86

issue

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-016-2816-2

journal_volume

158

pub_type

杂志文章

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Double balloon protection during carotid artery stenting for vulnerable carotid stenosis reduces the incidence of new brain lesions.