الفهرس 
Atherosclerosis in the carotid arteriesOnly 14 pages are availabe for public view
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Abstract
ckground: Embolic protection devices may decrease periprocedural thromboembolic complications during carotid angioplasty and stenting (CAS). When using proximal protection devices (PPDs), protection starts before crossing the lesion. However, in the medical literature, its use is scarcely reported compared with that of distal protection devices (DPDs). The objective of this study was to compare periprocedure complications, morbidity, and mortality among 40 consecutive cases of CAS performed with PPDs or DPDs.
Patients and Methods: This was a prospective comparative clinical study in which Forty patients were recruited consecuitively among those who were attending ain shams university hospital and Arab contactors medical center for carotid artery stenting during the period between July 2016 and June 2019, in hospital periprocedure complications, morbidity, and mortality including ischemic stroke or transient ischemic attack, myocardial infarction (MI), and death, clinical follow up after 1 and 6 months, were globally registered,and the results in PPD and DPD groups were compared.
Results: 20 patients were treated with DPD and 20 with PPD; Postprocedure new lesions were observed on DW-MRI in 10 patients (50%) in the DPD group and 6 (30%) in the PPD group, which was not statistically significant (p=.197). Ischemic neurologic events were observed in 6 patients (15%) in the entire study population. 4 patients in both groups experienced symptoms of neurologic deficit improved within 24 hours (TIA) while 2 patients in the DPD group experienced symptoms of neurologic deficit continued after 24 hours and NIHSS score ≤ 4 (minor stroke); however, this was not statistically significant (p=0.244), No cases of myocardial infarction, cerebral hemorrhage or death on both groups were detected.
Conclusion: Carotid angioplasty and stenting is a safe procedure to treat carotid disease in our patients. The two treatment strategies did not differ significantly in stroke, TIA, MI or death rates. Interestingly, PPD use was associated with a lower risk of ischemic lesions among the study population. Future RCTs or well-designed prospective real-world studies should compare PPD vs. DPD vs. the combination method in order to reach safer conclusions for the optimal practice for the interventionalists.