Proximal versus distal protection during carotid artery stenting: Analysis of the two treatment approaches and associated clinical outcomes

Maxim Mokin, Travis M. Dumont, Joan Mihyun Chi, Connor J. Mangan, Tareq Kass-Hout, Grant C. Sorkin, Kenneth V. Snyder, L. Nelson Hopkins, Adnan H. Siddiqui, Elad I. Levy

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Objective Cerebral protection device utilization during carotid artery stenting (CAS) has been shown to decrease risk of perioperative stroke. The two most commonly used devices are distal filters and proximal protection devices, which allow blood flow cessation or flow reversal. The goal of the present study was to examine anatomic and morphologic characteristics of the treated lesions using each type of cerebral protection device and compare clinical 30-day adverse event rates between the two cerebral protection groups. Methods We conducted a single-center, retrospective review of consecutive CAS cases with proximal protection devices that were matched with CAS cases using distal filter protection devices based on indication (symptomatic vs. asymptomatic), age, and gender. We reviewed clinical, anatomic, and morphologic characteristics of the stented lesions in cases of proximal or distal protection and also studied the rate of major adverse events within the first 30 days after the procedure. Results We identified a total of 70 patients treated with proximal protection devices who were matched in a blinded fashion to 70 cases with distal protection. There was a significantly higher number of high-risk lesions in patients who had CAS using proximal protection devices (P = 0.009). There was no significant difference in overall frequency of 30-day adverse outcomes (transient ischemic attack/stroke/reperfusion hemorrhage/death) between the two groups (P = 1.0). Conclusions Our study is the first attempt (to our knowledge) to review and compare anatomic and morphologic characteristics of the stented lesions in cases of proximal versus distal protection for CAS. Our data indicate that in properly selected patients both approaches could be equally safe and effective.

Original languageEnglish (US)
Pages (from-to)543-548
Number of pages6
JournalWorld neurosurgery
Volume81
Issue number3-4
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Adverse events
  • Carotid stenting
  • Distal protection
  • Embolic protection
  • Proximal protection
  • Treatment outcome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Proximal versus distal protection during carotid artery stenting: Analysis of the two treatment approaches and associated clinical outcomes'. Together they form a unique fingerprint.

Cite this