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

  • Interventional Neuroradiology
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Abstract

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.

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Acknowledgements

The authors are grateful to Mrs. Ogawa, Mrs. Nakamura, Dr. Tanemura, and Dr. Miura for their valuable assistance in preparation of this report.

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Authors and Affiliations

  1. Department of Neurosurgery, Mie University School of Medicine, 2-174, Edobashi, 514-8507, Tsu City, Mie Prefecture, Japan

    Fumio Asakura, Kenji Kawaguchi, Hiroshi Sakaida, Naoki Toma, Satoshi Matsushima, Keita Kuraishi, Hiroshi Tanemura, Yoichi Miura & Waro Taki

  2. Department of Radiology, Mie University School of Medicine, 2-174, Edobashi, 514-8507, Tsu City, Mie Prefecture, Japan

    Masayuki Maeda

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  1. Fumio Asakura
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  2. Kenji Kawaguchi
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  3. Hiroshi Sakaida
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  4. Naoki Toma
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  5. Satoshi Matsushima
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  6. Keita Kuraishi
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  8. Yoichi Miura
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  9. Masayuki Maeda
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  10. Waro Taki
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Correspondence to Waro Taki.

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Asakura, F., Kawaguchi, K., Sakaida, H. et al. Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices. Neuroradiology 48, 100–112 (2006). https://doi.org/10.1007/s00234-005-0003-x

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  • DOI: https://doi.org/10.1007/s00234-005-0003-x

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