Objective To determine safety and efficacy of employing flow reversal with proximal flow arrest using MOMA device for carotid stenting with or without angioplasty
Synopsis Carotid artery angioplasty and stenting (CAS) is comparable to CEA in preventing ischemic strokes in patients with symptomatic critical carotid stenosis. embolic protection devices were mandated to be used in the CREST trial. Several studies suggest that proximal balloon occlusion may be superior to distal protection device in preventing thromboemobolic events. MOMA device was used, safely and effectively, in the ARMOR Study for embolic protection. Proximal balloon occlusion with flow reversal using MOMA device has however never been studied.
Method We performed a retrospective review of our CAS database for patients who underwent stent-supported carotid revascularization in the acute and subacute stroke setting as well as TIA. We reviewed clinical and radiological data for a period of 0–6 months. The primary outcome measured was clinical evidence of ipsilateral stroke in the first 30 days. We also measured secondary outcomes including evidence of all-cause stroke from 0–6 months, perioperative angiographic outcome, preoperative complications, duration of hospitalization at time of procedure, sonographic or angiographic followup (if available) of the revascularized lesion within the first 6 months, functional scale at 30 days, and all-cause mortality.
Results 28 patients underwent Carotid Angioplasty and stenting using flow reversal with the help of Mo. Ma device: 15 females and 13 males with mean age of 70 years [range 56–87]. 85% of patients had Hypertension, 50% had Diabetes Mellitus and 50% of patients were current or previous smokers. 50% of the patients presented with stroke. 60% of the lesions presented as acute stroke and underwent revascularization under 1 week. 7% of patients underwent stunting in the subacute phase of the stroke, and 20% underwent stent after presenting with TIA. Abbott Precise stents were used in all of the studied cases. The 9 french Mo. Ma device was used in combination with Penumbra aspiration in all the cases as well. The average length of stay was 7 days, including patients who were admitted both for ischemic stroke and TIAs, or carotid stenting. No patients in the study had periprocedural strokes or postoperative stroke within the first 30 days in the ipsilateral circulation. One patient stay was complicated by hyper perfusion syndrome, but this episode was non-hemorrhagic. Another patient stay was complicated by myocardial infarction. Sonographic/Angiographic follow-up was available for 50% of patients. Of these patients, only 1 had evidence of 40% restenosis which was asymptomatic. One patient had evidence of endothelial thickening at site, but no thickening. None of these patients were symptomatic. 83% of patient had good functional outcome with Modified Rankin Score of 0–2. All of the patients with MRS greater than or equal to 3 had a poor functional scale secondary to their initial ischemic lesion.
Conclusion Flow reversal using MO. MA device is a safe and effective tool in preventing distal embolization during carotid stenting.
Disclosures R. Bo: None. A. Tiwari: None. K. Arcot: None. H. Dababneh: None. J. Farkas: None.
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