Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting.

Purpose: To assess the technical feasibility and the results of cerebral pr otection with the GuardWire Plus Temporary Occlusion & Aspiration System du ring carotid artery stenting for high-grade stenosis. Patients and Methods: In 20 patients 20 carotid artery stenoses were treated with stent placemen t under cerebral protection. A contralateral carotid occlusion was an exclu sion criteria for the use of the protection device. In all cases only aspir ation, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was p erformed before and 24 hours after the procedure. Results: The stent implan tation was successfully performed in all patients. in 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the sympt oms immediately disappeared after deflation of the balloon. In one case the re was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, i n one case a new contralateral lesion occurred after the procedure. Conclus ions: The cerebral protection procedure is technically feasible. The occlus ion of the internal carotid artery was not tolerated by all patients. The D W-MR imaging demonstrated cerebral lesions indicating the occurrence of cer ebral microemboli during the procedure. Further investigations are necessar y to determine if the use of the cerebral protection device will improve th e results of the carotid artery stenting for high-grade stenoses.