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Assessment of Reverse Flow as a Means of Cerebral Protection during Carotid Artery Stent Placement with Diffusion-weighted and Transcranial Doppler Imaging

Lookup NU author(s): Dr Sumaira MacDonald


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Purpose: To assess the effectiveness of flow reversal as an alternative means of cerebral protection by using transcranial Doppler recordings and diffusion-weighted imaging (DWI) as surrogate markers of brain injury.Materials and Methods: Eighteen patients with symptomatic carotid artery disease were recruited. Magnetic resonance imaging was performed before the intervention and at 3 and 24 hours and 30 days after the intervention to detect new ischemic lesions with DWI. Transcranial Doppler recordings were made during the procedure to assess for microembolic signals (MESs). Data were compared against data from a historical control cohort of patients who underwent CAS placement with or without filter protection (n = 15 each) under the same protocol in a different study.Results: There were fewer periprocedural new lesions on DWI in the reverse-flow cohort compared with the historical control cohort with filter protection (P = .084). Reverse flow revealed significantly fewer MESs during the whole procedure compared with the filter-protected group (P = .01) but not the unprotected group (P = .55). There was a marked decrease in MES counts for reverse flow protection during the embologenic stages of the procedure (P = .004).Conclusions: Use of the reverse flow device was associated with fewer overall lesions on DWI and proportionately fewer positive scans compared with the use of filter-type devices (P = .08, not significant). Transcranial Doppler recordings demonstrated a significant reduction in embolization to the brain during carotid artery stent placement with the use of reverse-flow cerebral protection.

Publication metadata

Author(s): Goode SD, Hoggard N, Macdonald S, Evans DH, Cleveland TJ, Gaines PA

Publication type: Article

Publication status: Published

Journal: Journal of Vascular and Interventional Radiology

Year: 2013

Volume: 24

Issue: 4

Pages: 528-533

Print publication date: 01/04/2013

Online publication date: 23/02/2013

Acceptance date: 18/12/2012

ISSN (print): 1051-0443

ISSN (electronic): 1535-7732

Publisher: Elsevier


DOI: 10.1016/j.jvir.2012.12.014


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