Role of the Distal Balloon Protection Technique in the Prevention of Cerebral Embolic Events During Carotid Stent Placement

Abstract

Background and Purpose-We sought to quantitatively and qualitatively evaluate the release of atheromatous plaque debris induced by carotid stenting procedures. Methods-Eight patients with severe carotid atheromatous stenoses were treated by stent implantation under distal balloon protection. Blood samplings were obtained after stent deployment in the blood pooled below the inflated protection balloon. The samples were centrifuged and evaluated for plaque debris with the use of light microscopy. The debris release was quantitatively estimated by dividing the total volume of debris obtained by the mean debris size. Five patients without endovascular procedure were used as a control group. Results-The 2 main debris types found were nonrefringent cholesterol crystals (4 to 389 m; 115 to 8697 in number) and lipoid masses (7 to 600 m; 341 to 34 000 in number). There was a statistically significant difference compared with the samples obtained in the control group (Pϭ0.017). Conclusions-Blood

Cerebral Protection During Carotid Artery Stenting

“…18 The present study shows that embolic particulates that are commonly released during carotid artery stent implantation 3,4 can be captured by distal filter protection devices. This is the clinical confirmation of the experience with filter protection in the ex vivo model reported by Ohki et al 13 Debris was captured in 83.7% of procedures compared with 81% 12 and 100% 14,15 in previously published studies in which occlusive balloons were used for protection. The size of the particles detected in the present study (289.5Ϯ512 m in diameter in the major axis; range, 1.08 to 5043.5 m) was greater compared with the ex vivo filter evaluation (226Ϯ130 m) 13 and 1 of the distal occlusive balloon studies (54.4 mm crystal and 110.67 mm lipoid mass) 5 and smaller compared with another distal balloon protection study (800 m).…”

“…This result confirms the data of previously reported studies evaluating different emboli protection devices during percutaneous intravascular interventions. [11][12][13][14][15] Our study confirms that this method of cerebral protection 18,25 is feasible and safe and that it limits intracranial debris embolization. Therefore, it strongly supports the use of protection devices during percutaneous carotid stenting.…”

“…14 In our experience, as well as in all previous observations, particles Ͼ300 m were found in all filters with debris. [12][13][14][15]18 The microcirculation encompasses vessels with diameter Ͻ300 m. 22 The arterial network arborizes from the aorta to arteries up to 400 to 300 m, small arteries with diameter between 300 and 100 m, arterioles with diameter between 100 and 12 m, and capillaries with diameter of approximately 12 m. In the present study 100% of filters with materials presented particles Ͼ300 m, and 52% of filters presented particles Filters with particles Ͼ300 m, major axis 31/31 (100%)…”

“…[12][13][14][15][16][17][18][19] In light of novel observations made by Reimers et al 18 suggesting the safety and feasibility of filter devices for carotid artery stenting, the present prospective study was designed to analyze histopathologically debris collected during intravascular percutaneous carotid artery stent implantation with the use of a recently available protection device.…”

Tratamiento con endoprótesis y espirales de un pseudoaneurisma asociado a una estenosis en la arteria carótida interna

“…Los resultados de estas endoprótesis están ampliamente probados a medio plazo aportando ventajas sobre el tratamiento quirúrgico convencional 6 . El perfeccionamiento de los materiales y de los mecanismos de protección y liberación hace que cada vez sea una práctica mas habitual, con índices de morbi-mortalidad bajos 9 . El desarrollo de endoprótesis cubiertas, en el tratamiento de lesiones aneurismáticas en otros territorios anatómicos (aorta abdominal y torácica) ha aportado suficientes datos para tratar el mismo tipo de lesiones en el territorio carotídeo; sin embargo, estas prótesis, teórica-mente ideales para el tratamiento del caso que nos ocupa, están en fase de desarrollo, intentando conseguir el mínimo diámetro del sistema de transporte y liberación 4,17 .…”