CORRESPONDENCE: LETTERS TO THE EDITOR
Reply
Andrej Schmidt, MD*,
Dierk Scheinert, MD and
Giancarlo Biamino, MD
* Klinische und Interventionelle Angiologie, Universität Leipzig—Herzzentrum, Strümpellstrasse 39, 04289 Leipzig, Germany (Email: Andrej.Schmidt{at}gmx.de).
Dr. Parodi mentions his experience with a similar protection device, the PAES (Parodi antiembolism system) (1). Because of the requirement of brevity of our study (2), the comparative technical discussion of both systems (MO.MA vs. PAES) was not possible. An advantage of the PAES over the MO.MA system could be the potential continuous retrograde flow through the target lesion during the intervention. Establishment of a continuous retrograde flow in the internal carotid artery using this concept has been demonstrated in an animal model (3). However, there are no scientific data demonstrating and quantifying that, during the critical phases of stent placement, delivery and postdilation of the PAES permits an effective retrograde flow in humans. Dr. Parodi mentioned in his study (1) the use of this protection device in nine patients. Transcranial Doppler monitoring revealed no microembolic signals (MESs) during clamping of the common carotid artery in these patients. In our study, using the MO.MA system there was also a considerable number of subjects (48% of 21 patients) showing no MESs during stent deployment and during balloon dilation (29% of 21 patients). It is regrettable that a controlled multicenter registry, showing the safety and feasibility of the PAES, as it has been conducted recently using the MO.MA system (4), is not yet available. A randomized comparison between the PAES and MO.MA device using transcranial Doppler with detection of MESs would be of interest.
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References
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1. Parodi JC, LaMura R, Ferreira LM, et al. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices J Vasc Surg 2000;32:1127-1136.[CrossRef][Web of Science][Medline]
2. Schmidt A, Diederich KW, Scheinert S, et al. Effect of two different neuroprotection systems on microembolization during carotid artery stenting J Am Coll Cardiol 2004;44:1966-1969.[Abstract/Free Full Text]
3. Bates MC, Dorros G, Parodi J, Ohki T. Reversal of the direction of internal carotid artery blood flow by occlusion of the common and external carotid arteries in a swine model Catheter Cardiovasc Interv 2003;60:270-275.[Medline]
4. Reimers B, Sievert H, Schuler G, et al. Proximal endovascular flow blockage for cerebral protection during carotid artery stentingresults from a prospective multicenter registry. J Endovasc Ther 2005;12:156-165.[CrossRef][Web of Science][Medline]
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