Key result
The use of distal filter devices during carotid angioplasty and stenting significantly reduced the incidence of new ipsilateral ischemic lesions on MRI compared to unprotected stenting (52% vs 68%).
Why the study?
Does the use of distal filter devices during carotid angioplasty and stent placement reduce the incidence of new DWI lesions in patients with high-grade carotid stenosis?
Cohort (n=243)
Single-blind
No
Does the use of distal filter devices during carotid angioplasty and stent placement reduce the incidence of new DWI lesions in patients with high-grade carotid stenosis?
Distal filter devices during carotid stenting reduce new silent ischemic lesions overall, but this benefit may not extend to older (>75 years) or asymptomatic patients.
Filter use was associated with fewer new lesions; leaves open clinical benefit and applicability to older or asymptomatic patients.
BACKGROUND AND PURPOSE: The routine use of distal filter devices during carotid angioplasty and stent placement (CAS) is controversial. The aim of this study was to analyze their effects on the incidence of new diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke in important subgroups. MATERIALS AND METHODS: DWI was performed immediately before and after CAS in 68 patients with and 175 without protection, and patients were further subdivided according to their age or symptom status. RESULTS: The proportion of patients with new ipsilateral DWI lesion(s) was significantly lower after protected versus unprotected CAS (52% versus 68%), as well as in symptomatic patients (56% versus 74%) or those at or younger than 75 years of age (46% versus 67%; all P < .05). Similarly, the total number of lesions was significantly lower after protected versus unprotected CAS (median, 1; interquartile range [IQR], 0-2; versus median, 1; IQR 0-4.75) and in symptomatic patients (median, 1; IQR, 0-3; versus median, 2; IQR, 0-6) or those at or younger than 75 years of age (median, 0; IQR, 0-2; versus median, 1; IQR, 0-4; all P < .05). In contrast, for asymptomatic patients (48% versus 52%; P = .8; median, 0; IQR, 0-2; versus median, 1; IQR, 0-2.5; P = .6) or those older than 75 years of age (73% versus 69%; P = .7; median, 1; IQR, 0-4; versus median, 1.5; IQR, 0-5.75; P = .6), the proportion of patients with new lesion(s) and the total number of these lesions were not significantly different between protected and unprotected CAS. CONCLUSIONS: The use of distal filter devices generally reduces the incidence of new DWI lesions; however, this beneficial effect might not necessarily pertain to older and asymptomatic patients.
No takes yet. Share an insight, caveat, or question.
Kastrup et al. (2007) conducted a cohort in High-grade carotid stenosis (n=243). Distal filter devices (cerebral protection) vs. Unprotected carotid angioplasty and stent placement was evaluated on Proportion of patients with new ipsilateral diffusion-weighted imaging (DWI) lesion(s) (p=<0.05). The use of distal filter devices during carotid angioplasty and stenting significantly reduced the incidence of new ipsilateral ischemic lesions on MRI compared to unprotected stenting (52% vs 68%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: