LAUSR

OBJECTIVE Two main types of embolic protection devices are used during carotid artery stenting (CAS): distal protection devices (DPDs) and proximal protection devices (PPDs). We compared complications, clinical outcomes, and new ischemic lesions on diffusion weighted image (DWI) between patients who underwent CAS using DPD or PPD. METHODS We performed a retrospective review of patients who underwent CAS between March 2010 and January 2016. Periprocedural and 30-day adverse events and new ischemic lesions on DWI after CAS were evaluated. RESULTS CAS was performed in 103 patients (DPD: 60, PPD: 43). The number of patients with new ischemic lesions was higher in the DPD than PPD group (78% versus 56%, P = 0.014). Most lesions (>90%) were tiny (≤ 3 mm) and average number of new tiny lesions per patient was significantly higher in the DPD than PPD group (mean 9.6 versus 4.0, P = 0.008). No significant differences in periprocedural and 30-day adverse rates were noted between two groups. Intolerance during the procedure was noted in five patients (12%) in the PPD group, four of whom had poor collateral circulation. CONCLUSIONS The number of new ischemic lesions per patient and the incidence of ischemic lesions on DWI were significantly higher in the DPD than PPD group. The lack of differences in periprocedural and 30-day adverse rates between two groups suggests that cerebral microemboli itself may not be associated with clinical outcomes. For patients with poor collateral status, DPDs should be used preferentially to avoid neurologic compromise associated with PPDs.