Proximal balloon-guided catheter with flow inversion vs. distal filter protection during the carotid stent placement, a seven years experience in a Colombian reference center

Abstract

Background and purpose The carotid stent placement as a therapeutic option for carotid stenosis has been increasing among years; therefore, studies are required to evaluate the security and efficacy of its materials. The purpose of this study was to evaluate the distal filter and the proximal balloon-guided catheter with flow inversion as protection devices during carotid angioplasty and stenting. Methods This is a retrospective, observational study of patients diagnosed with carotid stenosis treated with angioplasty between January 1, 2014, and June 30, 2020; we analyzed a radiology service database to compare the distal filter and the proximal balloon-guided catheter as protection devices during angioplasty. Results One hundred seventy-five angioplasties were performed, the distal filter was the most prevalent embolic protection device used (66%), patients baseline characteristics did not differ between groups with different embolic protection devices, except for history of dyslipidemia ( p < 0.000). As well, we did not find any significant differences between the groups in the device related complications, intervention time ( p = 0.140), unrelated complications ( p = 0.693) and functional independence at 90 days (p = 0.096). Conclusions In our study the proximal balloon-guided catheter and the distal filter protection device as protection devices during the carotid stenting didn't show significant differences regarding complications related to the system.

Elective carotid stenting fulfills quality standards defined in guidelines

“…The consistent use of filter systems in American CAS studies (CREST, ACT-1), years of good experiences, and standardized ap-plication with corresponding interventionalist training support use of such systems. Balloon catheters for temporary closure of the external and internal carotid arteries or flow reversal catheters with additional connection to the femoral vein can ensure protection against embolic complications similar to filter systems [26]. Due to the limited availability and limitations regarding the inner lumen, they were not used in our study.…”

“…Für die Verwendung von Filtersystemen sprachen deren konsequente Verwendung in amerikanischen CAS-Studien (CREST, ACT-1), jahrelange gute Erfahrungen und die standardisierte Handhabung mit entsprechendem Training der Interventionalisten. Ballonführungskatheter zum temporären Verschluss der ACE und ACI oder Flussumkehrkatheter mit zusätzlicher Verbindung zur V. femoralis können ähnlich wie Filtersysteme einen Schutz gegen embolische Komplikationen gewährleisten [26]. Aufgrund der eingeschränkten Verfügbarkeit und Limitierungen bezüglich des Innenlumens wurden sie im Rahmen unserer Studie nicht verwendet.…”