Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices

• Published in: Neuroradiology 2006-02, Vol.48 (2), p.100-112
• Main Authors: ASAKURA, Fumio, KAWAGUCHI, Kenji, SAKAIDA, Hiroshi, TOMA, Naoki, MATSUSHIMA, Satoshi, KURAISHI, Keita, TANEMURA, Hiroshi, MIURA, Yoichi, MAEDA, Masayuki, TAKI, Waro
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - methods; Biochemistry and metabolism; Biological and medical sciences; Blood clots; Carotid Stenosis - diagnosis; Carotid Stenosis - therapy; Central nervous system; Cerebral Angiography; Chi-Square Distribution; Coronary vessels; Diffusion Magnetic Resonance Imaging; Female; Fundamental and applied biological sciences. Psychology; Humans; Intracranial Embolism - diagnosis; Intracranial Embolism - prevention & control; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Nervous system; NMR; Nuclear magnetic resonance; Perception; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Stents; Treatment Outcome; Vertebrates: nervous system and sense organs; Vision
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-005-0003-x

We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0 +/- 6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P = 0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS.