Keywords:
Interventional vascular, Neuroradiology brain, Vascular, CT-Angiography, MR-Angiography, Fluoroscopy, Stents, Angioplasty, Catheters, Acute, Embolism / Thrombosis, Arteriosclerosis
Authors:
R. Gandini, E. Pampana, D. Morosetti, A. Chiaravalloti, S. Fabiano, A. Bindi, G. Loreni, G. Simonetti; Rome/IT
DOI:
10.1594/ecr2013/C-0780
Results
Before the procedure all patients were matched following the criteria present in table I and divided in two different grous.
In group 1 characterized by 19 patients with hyperintense plaque on after-contrast T1-weighted images,
12 stenoses (63.1 %) were located in the right internal carotid artery,
7 (37.9 %) in the left internal carotid artery.
The degree of stenosis averaged 67 ± 6%,
in particular stenoses >70%were found in 10 patients (52.6%) and stenoses averaged from 50 to 70% were found in 9 patients (47.4%).
In all symptomatic patients the carotid plaque with the characteristics of inflammation was situated on the same side where direct and indirect signs of brain suffering were present.
In only one (5.2%) patient bilateral inflamed plaques were diagnosed,
however it was decided to treat the lesion which was related to the clinical symptomatology and to the MR findings,
which was characterized by a higher stenosis degree,
while the contralateral stenosis,
which was equivalent of 55 % stenosis degree,
was treated in a following endovascular treatment and isn’t considered in this study.
Twelve patients (63 %) with inflammation signs in the HR-MR examination,
presented dislypidemia,
with very high levels of Low Density Liporotein (LDL) and cholesterol .
In only one patient of the group 2 dyslipidemia was noted (p<0.05).
In all patients corresponding to group 2 a high blood pressure was evaluated compared to six patients of group 1 (P<0.05).
In two patients a type II aortic arc was present and a “shuttle” guided catheter was necessary in order to achieve higher stability and better control over the dedicated devices.After Mo.Ma protection devicedisassemblement,atheromatous debris was found in the basket in 11 patients (57.9%).
In patients in which atheromatous debris was visible in the filter basket,
other two additional 20 cc of syringes of blood were aspirated with no debris detected at the end of the procedure.
In all procedures no significant residual stenosis (residual stenosis > 30 %) resulted.
In group 2 characterized by 12 patients without any signs of inflamed plaque,
9 (75%) were located in the right internal carotid artery,
3 (25%) in the left internal carotid artery; the degree of stenosis averaged 78.7 ± 4.5 %,
with 10 patients (32.2%) who presented stenoses >70% and 2 patients (6.4%) with stenoses averaged from 60 to 70%.No atheromatous debris were found in the filter at the end of the procedure in group 2.
Technical success was obtained in all procedures (100%).
No technical complications occurred at the end of the procedure.
One TIA (5%) was observed in the group of patients treated with Mo.Ma filter protection device,
likely related to hypoperfusion caused by the device.
In this patient an MRI examination with Diffusion Weighted Imaging and ADC map was immediately performed and no signs of acute ischemia were identified.No major adverse cerebrovascular events in hospital-stay and at 30 day follow-up were observed in group 2 of patients.There wasn’t a statistical differences in the complication incidence between the two groups of patients (P<0.05).Neither periprocedural death nor myocardial infarction occurred.
Clinical follow-up data and DUI at 30 days,
3,
6 months,
and 1 year were obtained and all implanted stents remained patent.Mean procedure time was higher in procedures in which Mo.Ma.
protection device was deployed (procedure with Mo.Ma.
protection device lengthened of 8 ± 1.3 minutes).