Cerebral Embolization during Transcervical Carotid Stenting with Flow Reversal: A Diffusion-Weighted Magnetic Resonance Study

Microembolization During Carotid Artery Stenting in Patients With High-Risk, Lipid-Rich Plaque

“…The lesions were ipsilateral in 78% of patients, underlining the CAS-associated risk and the need of further cerebral protection improvement. Similar data were reported by Faraglia et al (26) and Leal et al (27), who found new lesions in 13.9% and 12.5% of patients undergoing trans-cervical CAS under flow reversal protection, respectively. Predictors of total number of MES.…”

The results of a simplified technique for safe carotid stenting in the elderly

“…It is not a comparative study with CEA or transfemoral CAS. Theoretically, compared with CEA, there is less surgical trauma, less postoperative pain, no nerve injuries according to the reported series, [9][10][11][12][13][14][15][16]19,20 and shorter hospital stay. However, the atheroma remains in the ICA and microembolization, despite the use of the filter or through the stent during or after the procedure, remains a problem.…”

“…Transcervical CAS with surgical cutdown and cannulation of the proximal CCA has been attempted either by direct filter insertion to the distal ICA, 9,10 or by ICA flow reversal. [11][12][13][14][15][16] In the first technique, the carotid lesion is crossed unprotected, and in the second technique, one prolonged retrograde flow may produce brain damage.…”

“…By using this technique, microembolization had probably occurred during crossing the carotid lesion for filter insertion. 9,10 Carotid flow reversal by occluding the common carotid artery (CCA) and creating a fistula between this artery and the jugular vein has the advantage of crossing the lesion under retrograde flow. This technique has been applied to a relatively small number of patients with good clinical results in terms of ischemic events and mortality.…”

“…[9][10][11][12][13][14][15][16][17] Using this technique in a series of 48 octogenarians unsuitable for transfemoral CAS, Faraglia et al 9 has reported a 2.1% incidence of ischemic events and 13.8% incidence of intraoperative embolization rates, measured by diffusion-weighted-magnetic resonance imaging (DW-MRI). 9 Palombo et al 10 compared filter protected transcervical with transfemoral CAS and have found a significant decrease in transient ischemic attacks (TIAs) and stroke (2.3% vs 19.8%; P Ͻ .01), as well as postprocedure brain embolization in DW-MRI (14.3% vs 36.8%; P ϭ .015) after the transcervical procedure. By using this technique, microembolization had probably occurred during crossing the carotid lesion for filter insertion.…”