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●Abstract● Objective: Carotid artery stenting (CAS) using a filter-type distal protection device (F-DPD) allows minimal interruption of blood flow and might be useful for patients with inadequate collateral circulation. The present study examines the feasibility and safety of CAS using F-DPD rather than carotid endarterectomy (CEA) for carotid vascular reconstruction in patients with internal carotid stenosis accompanied by contralateral internal carotid occlusion (ICO-ICS). Method: The study included 17 consecutive patients with ICS-ICO (mean age 69 years, all males). Carotid plaques were evaluated using blackblood MRI and diagnosed as "soft plaque" when the relative overall plaque signal was ≥ 1.25 on T1-weighted images. As a general rule, CAS using F-DPD was performed for ICS-ICO and CEA was considered only when soft plaque was identifi ed. Preoperative examinations, periprocedural complications, and the occurrence of restenosis were analyzed retrospectively. Results: Vascular reconstruction by either CAS (13 patients) or CEA (4 patients) was adequate in all patients with ICS-ICO. The relative overall plaque signal was 1.14 ± 0.36 in CAS group and 1.48 ± 0.22 in CEA group, respectively. Two of 3 CAS operations using a balloon-type DPD to treat patients with soft plaque proceeded under general anesthesia because of insuffi cient ischemic tolerance. Although we did not confi rm any symptomatic ischemic complications, all three of these patients had asymptomatic high-signal spots on post-operative diffusion weighted images (DWI). High-signal lesions on DWI emerged in the contralateral hemispheres in 2 patients after CAS using F-DPD. Slow-fl ow and no-fl ow did not arise during any CAS procedures using F-DPD. Post-procedural prolonged hypotension and bradycardia were evident in 3 patients after CAS. Restenosis (> 50%) did not arise in patients during an average follow-up period of 12 months after both CAS and CEA. Conclusion: With proper selection of patients based on plaque characterization and meticulous measures against periprocedural hypotension, CAS using F-DPD as a fi rst line procedure is feasible, safe and effective. ●Key Words● carotid stenting, contralateral carotid occlusion, distal protection, plaque characterization

jnet

Vascular Reconstruction for Internal Carotid Artery Stenosis with Contralateral Carotid Occlusion: Carotid Stenting with Use of Filter-type Distal Protection Device and Its Short-term Outcome