Author + information
- Received March 7, 2013
- Revision received June 7, 2013
- Accepted July 3, 2013
- Published online November 1, 2013.
- Manuel N. Cano, MD, PhD∗∗ (, )
- Antônio M. Kambara, MD, PhD∗,
- Silvia J.F. de Cano, MD∗,
- Luiz Antônio Pezzi Portela, MD, PhD∗,
- Ângela Tavares Paes, PhD∗,
- J. Ribamar Costa Jr., MD∗,
- Alexandre Antônio Cunha Abizaid, MD∗,
- Samuel Martins Moreira, MD, PhD∗,
- Amanda G.M.R. Sousa, MD, PhD∗ and
- J. Eduardo Moraes Rego Sousa, MD, PhD∗
- ↵∗Reprint requests and correspondence:
Dr. Manuel N. Cano, Rua Sampaio Viana, 203 Paraiso, São Paulo 04004-000, Brazil.
Objectives This study sought to randomly compare cerebral protection with ANGIOGUARD (Cordis Corporation, 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 were analyzed.
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 to ANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwent DW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protection used analyzed the images. Univariate and multivariate logistic models were fitted to analyze new ischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due to differences 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 group versus 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 < 0.001). Most lesions were small (<0.5 mm) and localized in the ipsilateral territory. One patient in the ANGIOGUARD group had a minor stroke during CAS (1.66%).
Conclusions New ischemic lesions seen on DW-MRI were present in both groups in >60%, but the number of lesions per patient was greater in the ANGIOGUARD group. No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2013.
- Revision received June 7, 2013.
- Accepted July 3, 2013.
- American College of Cardiology Foundation