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Flow reversal versus filter protection: a pilot carotid artery stenting randomized trial.
Castro-Afonso, Luis Henrique de; Abud, Lucas Giansante; Rolo, Jaicer Gonçalves; Santos, Antônio Carlos dos; Oliveira, Lívia de; Barreira, Clara Monteiro Antunes; Velasco, Tonicarlo Rodrigues; Pontes-Neto, Octávio Marques; Abud, Daniel Giansante.
Afiliação
  • Castro-Afonso LH; Division of Interventional Neuroradiology, Division of Neuroradiology, and Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Circ Cardiovasc Interv ; 6(5): 552-9, 2013 Oct 01.
Article em En | MEDLINE | ID: mdl-24084627
BACKGROUND: Carotid artery stenting (CAS) has become an alternative treatment for patients presenting symptomatic carotid artery stenosis. The improvement in clinical outcomes with CAS has been associated with the development of embolic protection devices. The trial aim is to compare flow reversal versus filter protection during CAS through femoral access. METHODS AND RESULTS: Patients were randomly enrolled in CAS using flow reversal or filter protection. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS. The secondary end points included major adverse cardiac and cerebrovascular events, transient ischemic attack, and definitive ischemic brain lesions on fluid-attenuated inversion recovery magnetic resonance image at a 3-month follow-up. Ischemic brain lesions were assessed by a 3T magnetic resonance image. Neurological outcomes were evaluated by means of the National Institutes of Health Stroke Scale and the modified Rankin Scale (mRS). Forty consecutive patients were randomly assigned. Compared with flow reversal (n=21), filter protection (n=19) resulted in a significant reduction in the incidence (15.8% versus 47.6%, P=0.03), number (0.73 versus 2.6, P=0.05), and size (0.81 versus 2.23 mm, P=0.05) of new ischemic brain lesions. Two patients, 1 from each group, presented transient ischemic attack at 3-month follow-up. There were no major adverse cardiac and cerebrovascular events in the hospital or at 3-month follow-up. CONCLUSIONS: In this small sample size trial, filter protection was more effective than flow reversal in reducing ischemic brain lesions during CAS through femoral approach. CLINICAL TRIAL REGISTRATION URL: http://portal2.saude.gov.br/sisnep/. Unique identifier: 0538.0.004.000-10.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Isquemia Encefálica / Estenose das Carótidas / Implante de Prótese Vascular / Dispositivos de Proteção Embólica Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2013 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
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XML
PubMed Links
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Isquemia Encefálica / Estenose das Carótidas / Implante de Prótese Vascular / Dispositivos de Proteção Embólica Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2013 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos