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To assess the feasibility, safety, and efficacy of carotid artery stenting with filter device.Between May 2001 and July 2002, a total of 96 consecutive patients (100 lesions) who presented with symptomatic70% diameter stenosis, asymptomatic90% diameter stenosis or post-endarterectomy as well as post-radiotherapy hemodynamically significant stenosis underwent carotid artery stenting with filter protection at our institute. The mean age of the patients was 72 (range 51-91). There were 22 female (23%), and 74 male (77%). Of the 96 patients, 62 patients (65%) did not filled the NASCET surgical criteria and 24 (26%) were classified as ASA 4. All the patients underwent pretreatment with antiplatelet agents. All procedures were performed with a standardized monitoring system by a multidisciplinary team. Filtration system for cerebral protection was consistently used. Outcome measures were procedural atheroembolic events, including all-stroke and death rates up to 30 days.A protection system type "TRAP" (Microvena, Italy) or a protection system type "EPIFILTER" (Boston Scientific, USA) were employed in 28% and 67% of cases, respectively. In the remaining 5% it was not possible to cross the stenosis with the filter. The stent placement was achieved in 95 of the procedures (95%). In 86% of cases a primary stenting technique was performed, with balloon pre-dilation of the lesion and subsequent stent advancement through the stenosis accounting for 9% of cases. At the time of protection system removal, 21 filter (21%) showed presence of macroscopic particles. We recorded 8 (8%) homolateral neurological events: two major strokes, one minor stroke and five TIAs (all the patients with TIA fully recovered within 2 hours). General complications (5%) included one lesion of the median nerve, two groin haematomas (one with disability for the patient, and one requiring surgery), one myocardial infarct and one lower limb ischaemia requiring surgical intervention. All major complications (4%) (two major strokes, one myocardial infarct and one lesion of the median nerve) occurred within the first 31 cases, the 69 following procedures not showing any neurological or non-neurological major events. At 30 days all patient were still alive.Filter protection during carotid artery stenting seems technically feasible as well as reasonably safe and effective. The EPIFILTER system turned out to be of easier employment due to its "monorail" system and because it does not usually need a catheter of dedicated recovery. Further studies in larger groups of patients are required to best characterize criteria guiding the choice for the right protection system.

Objecti6e: In several previous studies, including one of our own, CT and MRI provided similar information on N2 detection in the staging of lung cancer. Both imaging techniques can be considered effective in detecting enlarged mediastinal lymph nodes but the results are often inaccurate when confronted with pathological findings. The purpose of this study was to assess the diagnostic accuracy of gadolinium‐DTPA enhanced MRI in the detection of mediastinal lymph nodes in lung cancer. Methods: A prospective study to compare standard unenhanced MRI and Gd‐DTPA enhanced MRI was carried out in patients with diagnosed lung cancer. The study focused on the status of mediastinal lymph nodes. Gd‐DTPA was administered at a dosage of 0.2 mmol:kg before T1 weighted sequences. Qualitative visual analyses of both standard and contrast enhanced MRI images were performed on each patient by 2 independent radiologists. The imaging results were then compared to pathological findings obtained after surgical operation. Results: In the identification of mediastinal lymph node metastases standard MRI was 62% sensitive, 100% specific and 74% accurate whereas Gd‐DTPA enhanced MRI was 100% sensitive, 91% specific and 97% accurate. Conclusions: Gd‐DTPA enhanced MRI was more accurate than standard MRI in the detection of metastatic lymph nodes in patients with lung cancer. These initial results can be considered encouraging especially with regards to the reduction of false negative findings although further confirmation is, understandably, required. © 1997 Elsevier Science B.V.