Carotid Artery Stenting Protected With an Emboli Containment System

Abstract

Background and Purpose-Fear of distal embolization and stroke has aroused concern regarding carotid stenting. Devices to protect the cerebral circulation may make carotid stenting safer. Methods-A multidisciplinary study group tested a balloon occlusion-aspiration emboli entrapment device in conjunction with carotid stenting. The device consists of an elastomeric balloon on a steerable wire with a detachable adapter that inflates and deflates the distal temporary occlusion balloon. An aspiration catheter is used to remove trapped emboli after stenting and before occlusion balloon deflation. Results-Seventy-five patients with severe internal carotid artery stenosis were treated with stents deployed with this cerebrovasculature protection system. All 75 patients (100%) had grossly visible particulate material aspirated, and all were treated successfully without major or minor stroke or death at 30 days. Preintervention stenosis was 81Ϯ10%, and residual stenosis was 5Ϯ7%. Nine patients (12%) had angiographic evidence of thrombus before intervention, but no patient had thrombus or vessel cutoff after the procedure. Four patients (5%) developed transient neurological symptoms during protection balloon occlusion, but symptoms resolved with balloon deflation. The 22 to 667 particles aspirated per patient ranged from 3.6 to 5262 m in maximum diameter (mean, 203Ϯ256 m). These particles included fibrous plaque debris, lipid or cholesterol vacuoles, and calcific plaque fragments. Conclusions-Protected carotid stenting was performed successfully and safely in this study early in the experience with cerebrovascular protection devices. Particulate emboli are frequent with stenting, and cerebral protection will likely be necessary to minimize stroke. Randomized trials comparing protected carotid stenting with endarterectomy are warranted.

Técnica para quantificação e qualificação de material coletado em filtros de proteção cerebral

“…A presença do cálcio e dos cristais de colesterol deve-se à fragmentação da placa do ateroma. Não há métodos idealmente padronizados para determinação da quantidade ou do tamanho de debris coletados em FPC nos diferentes estudos, mas a grande variância dos valores encontrados em nosso estudo ratifica outros achados 17,19,21,23 , suscitando o interesse de entendê-la melhor em relação às características clínicas e angiográficas dos pacientes com estenoses carotídeas.…”

Successful Surgical Repair of Transected Common Carotid Artery after 12 Hours from Trauma

“…The bleeding, intraluminal clot, compression symptoms caused by hematoma, concomittent injuries needing exploration, and infected wounds as relative contraindications (5). This therapeutic method may in future be more extensively applied in selected patients, especially with newly developed adjunctive neurologic protection devices (11,12).…”

Technique and Clinical Results of Carotid Stenting under Distal Protection

“…Various types of protection devices have been developed including distal balloon protection system, filter wires, and proximal flow control technique (Parodi's system) 1,5,6,8,10 . The results of carotid stenting improved after introduction of protection system as shown in our series (ischemic complication reduced from 21% to 1.5%) as well as recent reports.…”