Cerebral Protection During Carotid Artery Stenting

Abstract

Background and Purpose-Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation. Methods-Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting Ͼ70% diameter stenosis (mean, 82.1Ϯ11.1%). Mean age of the patients was 70.7Ϯ7.7 years; 75% were men, and 50% of patients had previous neurological symptoms. Results-In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters.

Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

“…22 Several authors have broadened the investigation of atheromatous plaque and embolization phenomena in the carotid, coronary, and peripheral vascular systems through the direct analysis of particles captured by the filter, trying to corroborate their atherosclerotic origin and establish an association between the volume and composition of the filter particles and postprocedural clinical events and MR imaging findings. 21,[25][26][27] In our study, 58.2% of the filters contained debris. Ultrastructural analysis revealed fibrin and platelets, foam macrophages, cellular debris, cholesterol crystals, collagen fibers, smooth muscle fibers, calcium, unidentified fibrillate, and amorphous material.…”

Observation of the embolus protection filter for carotid artery stenting

“…Only a few studies give a detailed morphological evaluation of the material retrieved during percutaneous procedure. Angelini et al (1) reported collection and histopathologic analysis of carotid debris from CAS. They showed scanning electron micrographic image and cross section of the filter membrane, identifying necrotic material, calcium precipitate, cholesterol clefts, fibrotic tissue fragments and evidence of platelet.…”

Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter

“…Although methods for filter observation have been reported, they contain technical difficulty and have not been widely spread [1,12]. We developed a debris observation method staining with HE [3,4].…”