الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Stroke is the third most common cause of disability and second most common cause of death worldwide. (Johnson et al., 2016)
Extra-cranial carotid stenosis accounts for about 15 - 20% of cerebral ischemic events. Among l00 acute stroke patients 16% had internal carotid artery (ICA) stenosis. (Elewa et al., 2013)
Carotid revascularization is superior to aggressive medical treatment in stroke prevention in patients with severe symptomatic or asymptomatic atherosclerotic carotid artery stenosis. (Elewa et al., 2013)
Carotid artery stenting (CAS) with protection devices is a less invasive non-inferior alternative to conventional carotid endarterectomy and became a widely used procedure in critical artery stenosis. However the role of protection devices is debatable. (Akinci et al., 2016)
The aim of this work was to compare the clinical and radiological outcomes following carotid artery stenting with or without the use of embolic protection device.
This study was conducted over one year on twenty-four subjects; fourteen patients had carotid artery stenting with embolic protection device and ten had carotid artery stenting without embolic protection device.
Symptomatic and asymptomatic patients were included in the study. Symptomatic patients were defined to have amaurosis fugax, TIA, Minor stroke or Major stroke with stenosis degree more than 50%. Asymptomatic cases had stenosis of more than 80 % and those were accidentally discovered during pre-operative assessment for coronary artery bypass graft (CABG) and during full assessment for irrelevant stroke.
Before procedure, consents were taken from all subject of the study. Complete history taking from patient or relatives including past medical history of any of the following risk factors: arterial hypertension, diabetes mellitus, cigarette smoking, cardiac disease, dyslipidemia, peripheral vascular disease, previous stroke, transient ischemic attack, and/or reversible ischemic neurological deficit. General examination was done including vital signs, heart and chest full examination. Clinical and neurological examination with assessment by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).
All patients had Carotid Artery Imaging, all carotid lesions were initially evaluated with Duplex ultrasonography (US) with high-frequency probes. Some patients had computed tomography angiography (CTA) or magnetic resonance angiography (MRA) for more evaluation of the stenosis.
During the procedure, twenty three patients were treated with WallStent except one patient with RoadSaver Stent. In protected patient group, a distal EPD was used. We used SpiderFx embolic protection system, and Filter Wire EZ.
After the procedure, patients received antiplatelets (Aspirin and Clopidogrel) with anticoagulation if needed. Diffusion-weighted magnetic resonance imaging was done within 24 hours after the procedure.
Data analysis was done using Statistical Package for Social Sciences (SPSS) Version 19.0 for windows. Frequencies and percentages were calculated for categorical variables, whereas means and SDs were calculated for continuous variables. Descriptive statistics of the study participants were conducted. T tests were used to compare the group with embolic protection and the non-protected group on continuous variables, whereas χ2 tests were used in comparing the two groups on categorical variables.
The results of the study showed the following:
• There was no statistically significant difference between both groups regarding the clinical outcome.
• There was statistically significant difference between both groups indicating silent embolic lesions and number of MRI-DWI lesions was significantly higher in non-protected group than in protected group.
• There was no statistically significant association between vascular risk factors and characteristics of the stenosis and the development of post-procedural clinical ischemic insults.
• There was no statistically significant association between vascular risk factors and characteristics of the stenosis and the development of post-procedural MRI-DWI lesions.