Observation of the embolus protection filter for carotid artery stenting

Abstract

Background: Carotid artery stenting (CAS) in high-surgical-risk patients is considered

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

“…The method was simple and required no special instrument. The debris was observed on the filter and the finding was consistent with preoperative imaging studies [4]. In this study, we revealed the function of the AG and FW, and evaluated the cause of the intraoperative flow impairment.…”

“…We developed a debris observation method staining with HE [3,4]. The method was simple and required no special instrument.…”

“…Loghmanpour et al compared the characteristics and outcomes of filter devices and reported that lower porosity, lower number of pores, and lower pore density were significant for minimizing peri-postporcedural adverse event [11]. We have developed a technique for microscopical filter observation and identified the characteristics of the debris [3,4]. In this study, observing the filter, the cause of flow impairment was evaluated in Angioguard XP (AG) (Cordis Corporation, Miami Lakes, FL, USA) and Filterwire EZ (FW) (Boston Scientific, Natick, MA, USA).…”

Obstruction of Pores in Distal Protection Filters and Angiographically-Documented Flow Impairment During Carotid Artery Stenting

“…[1][2][3][4][5][6][7] The observation that normal antegrade flow is restored in all patients with slow flow after filter retrieval strongly suggests that the occlusion of the pores in the filter membrane is responsible for the impaired antegrade flow. [1][2][3][4][5][6][7] Flow impairment, which has been associated with periprocedural ischemic events, 1,2 is thought to cause blood to stagnate just proximal to the filter, leaving debris floating in the proximal ICA column. This consequence of flow impairment requires the use of an aspiration catheter to remove blood in the ICA just proximal to the filter before it is retrieved.…”

Propagation-based phase-contrast X-ray microtomography of a cerebral protection device retrieved after carotid artery stenting

“…Until recently, the evaluation of the burden of embolic debris has been dependent upon visual inspection or performed using optical microscopy (Angelini et al, 2002;Rogers et al, 2004;Quan et al, 2005;Hayashi et al, 2009) or electron microscopy (DeRubertis et al, 2007;Brightwell et al, 2011). However, optical and electron microscopy require multiple steps of staining and thin-slice dissection.…”