Safety of Carotid Stenting – a Comparison of Protection Systems

Authors: O. Pavlík 1;  D. Václavík 1;  D. Kučera 2;  J. Návratová 3;  G. Solná 1;  M. Rabasová 4
Authors‘ workplace: Vzdělávací a výzkumný institut Agel, Neurologické oddělení, Vítkovická nemocnice a. s., Ostrava 1;  Vaskulární centrum, Vítkovická nemocnice a. s., Ostrava 2;  Radiologické oddělení, Vítkovická nemocnice a. s., Ostrava 3;  Katedra matematiky a deskriptivní geometrie, VŠB – Technická univerzita Ostrava 4
Published in: Cesk Slov Neurol N 2016; 79/112(5): 560-564
Category: Original Paper


To compare safety and efficacy of distal protection devices (filters) and the proximal protection device (Mo.Ma system) during carotid artery stenting (CAS) and to prove or reject lower incidence of new microembolic lesions with Mo.Ma protection. To determine the impact of microembolic lesions after CAS on cognitive functions.

Fifty-six patients were randomized into two groups according to the cerebral protection used (Filter vs. Mo.Ma group). All patients underwent brain magnetic resonance imaging (MRI) before and after stenting. Thirty-two patients were tested before and 30 days after stenting with Adenbrook Cognitive Examination revised (ACE-R) tests.

32.14% (n = 18) of all patients had new ischemic lesions on MRI after CAS, 32.43% (n = 12) of the Filter group patients (n = 37) and 31.58% (n = 6) of the Mo.Ma group patients (n = 19). Only 38.89% of all new ischemic lesions were located solely in the territory of the treated artery, 16.67% in the Filter group (p = 0.006) and 83.33% in the Mo.Ma group (p = 0.037). Significant decline in ACE-R test was found in one patient only.

New ischemic lesions after CAS were present on MRI in both groups with no significant difference. Significantly more lesions were located outside the territory of the treated artery in the Filter group and inside the territory in the Mo.Ma group. We did not prove negative impact of new lesions on the ACE-R tests results.

Key words:
carotid stenosis – embolic protection devices – magnetic resonance imaging – cognitive function

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: a Guideline for Healthcare Professionals From the American Heart Association. Stroke 2015; 46 (4): e87–9. doi: 10.1161/STROKEAHA.115.008661.

2. Stankovic G, Liistro F, Moshiri S, et al. Carotid artery stenting in the first 100 consecutive patients: results and follow-up. Heart 2002,88 (4): 381–6.

3. Vitek JJ, Al-Mubarak N, Iyer SS, et al. Carotid artery stent placement with distal balloon protection: technical considerations. Am J Neuroradiol 2005; 26 (4): 854–61.

4. Kastrup A, Groschel K, Krapf H, et al. Early outcome of crotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 2003; 34 (3): 813–9.

5. Jaeger HJ, Mathias KD, Hauth E, et al. Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery. Am J Neuroradiol 2002; 23 (2): 200–7.

6. Bijuklic K, Wandler A, Tubler T, et al. Impact of asymptomatic cerebral lesions in diffusion-weighted magnetic resonance imaging after carotid artery stenting. JACC Cardiovasc Interv 2013; 6 (4): 394–8. doi: 10.1016/j.jcin.2012.10.019.

7. Pinero P, González A, Mayol A, et al. Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion-weighted MRI study. Am J Neuroradiol 2006; 27 (6): 1338–45.

8. Bonati LH, Jongen ML, Haller S, et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9 (4): 353–62. doi: 10.1016/S1474-4422 (10) 70057-0.

9. Schnaudigel S, Groschel K, Pilgram MS, et al. New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy: a Systematic Review of the Literature. Stroke 2008; 39 (6): 1911–9. doi: 10.1161/STROKEAHA.107.500603.

10. Altinbas A, Algra A, Bonati LH, J et al. Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study – MRI Substudy. Stroke 2013; 45 (1): 146–51. doi: 10.1161/STROKEAHA.113.003397.

11. Schmidt A, Diederich KW, Scheiert S, et al. Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 2004; 44 (10): 1966–9.

12. Paraskevas KI, Lazaridis C, Andrews CM, et al. Comparison of Cognitive Function after Carotid Artery Stenting versus Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2014; 47 (3): 221–31. doi: 10.1016/j.ejvs.2013.11.006.

13. Rando DE, Caso PV, Leys D, et al. The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke 2008; 39 (11): 3116–27. doi: 10.1161/STROKEAHA.108.518357.

14. Lal BK. Cognitive function after carotid artery revascularization. Vascular Endovasc Surg 2007; 41 (1): 5–13.

15. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124 (4): e54–130. doi: 10.1161/CIR.0b013e31820d8c98.

16. Mioshi, E, Dawson K, Mitchel J, et al. The Addenbrooke‘s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementi screening. Int J Geriatr Psychiatry 2006; 21 (11): 1078–85.

17. Raisová M, Kopeček M, Řípová D, et al. Addenbrookský kognitivní test a jeho možnosti použití v lékařské praxi. Psychiatrie 2011; 15 (3): 145–50.

18. Bijuklic K, Wandler A, Hazizi F, et al. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective study. J Am Coll Cardiol 2012; 59 (15): 1383–9. doi: 10.1016/j.jacc.2011.11.035.

19. Qureshi AI, Luft AR, Sharma M, et al. Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting. Stroke 1999; 30 (10): 2086–93.

20. Sylivris S, Levi C, Matalanis G, et al. Pattern and significance of cerebral microemboli during coronary artery bypass grafting. Ann Thor Surg 1998; 66 (5): 1674–8.

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