Randomized comparison of distal and proximal cerebral protection during carotid artery stenting

ABSTRACT

Objectives This study sought to randomly compare cerebral protection with ANGIOGUARD (CordisCorporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa,California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging(DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions wereanalyzed.Background The choice of the type of cerebral protection during CAS is controversial.Methods From July 2008 to July 2011, 60 patients undergoing CAS were randomized toANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwentDW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protectionused analyzed the images. Univariate and multivariate logistic models were fitted to analyze newischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due todifferences between the groups. For the number of lesions, we used Poisson regression models.Results New ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD groupversus 66.7% of the Mo.Ma cohort (p » 0.787). The number of ischemic cerebral lesions per patient,when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs.a median of 10 in the ANGIOGUARD, p 60%, but thenumber of lesions per patient was greater in the ANGIOGUARD group. No death or disabling strokeoccurred during at least 1 year of follow-up in both cohorts.