Difficult retrieval of the EPI filterwire with a 5 French FR4 coronary catheter following carotid stenting

Abstract

Carotid angioplasty and stenting with an embolic protection device is emerging as a reasonable alternative to carotid endarterectomy in high-risk patients. The deployment and retrieval of these devices, however, can be problematic. We describe a case where a 5 Fr FR4 coronary catheter was used to retrieve an EPI Filterwire device following carotid stenting.

The PROFI Study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting)

“…They have to cross the lesion before the protection is installed, allow particles smaller than their pore sizes (100 m) to pass through them or, if not well adapted to the vessel wall, to pass along the filter. Beyond that, filters can become overloaded with debris, with the risk of spilling the contents of the filter during retrieval, and they can occasionally be difficult to retrieve (21,22). A proximal protection system may be more effective in preventing embolization, mainly because it is placed and functioning before the lesion is crossed, and induces reversed flow by occluding both the external carotid artery and the CCA.…”

Trapped Embolic Protection Device: A Salvage Technique

“…There have been descriptions of rescue strategies to retrieve trapped embolic protection filters including external carotid compression, rotation of the head to the contralateral side to change carotid angulation, use of different catheters like the vertebral and JR-four catheters and carotid endarterectomy (CEA) [3][4][5][6][7][8]. CEA for EPD retrieval can be performed safely in an emergent setting [7,8].…”

Double‐Wire Technique in Balloon‐Protected Carotid Artery Stenting

“…Flow impairment due to embolus captured within the filter occurred in 7.9–21.6% 2,4,5 . Additionally, filter retrieval remains troublesome 6–8 …”

“…Focused attention has been paid to filter devices in carotid artery stenting (CAS) even though no data has shown the superiority of “filter” embolic protection devices over the only “distal occlusion” embolic protection device, PercuSurge GuardWire (Medtronic AVE, Santa Rosa, CA). However, as protected CAS using filter devices has become widespread, the potential drawbacks of filter devices such as failed filter placement, filter‐induced spasm, flow impairment, and difficulty in filter retrieval have become clear 1–8 . Originally, protection against distal embolization for CAS was achieved with a distal occlusion balloon 9,10 .…”