Stent Placement versus Percutaneous Transluminal Angioplasty of Human Carotid Arteries in Cadavers in Situ: Distal Embolization and Findings at Intravascular US, MR Imaging, and Histopathologic Analysis

Abstract

Although stent placement and PTA were associated with equal distal embolization, the smooth surface and fully patent arterial lumen depicted at intravascular US and MR imaging postinterventionally may indicate that stent placement is preferable to PTA.

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.…”

Carotid Artery Stenting without Angioplasty and Cerebral Protection: A Single-Center Experience with up to 7 Years' Follow-Up

“…It is well-known that the highest potential for embolization occurs post-stent placement when the balloon crushes the plaque against the stent struts. 24,25 In our series, the 30-day composite rate of any stroke or death was 1.2% (0.8% for symptomatic and 0.4% for asymptomatic patients). These results are considerably below the 3% and 6% of maximum complication rates recommended in the American Heart Association guidelines for carotid endarterectomy of asymptomatic and symptomatic patients, respectively, 17 and compare favorably with rates found in patients enrolled in large trials of carotid stent placement (10% in the Carotid and Vertebral Artery Transluminal Angioplasty Study, 26 12.1% in the WALLSTENT [carotid stenting versus endarterectomy in patients with symptomatic carotid stenosis] trial, 27 4.8% in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy study, 4 6.8% in the Stent-Protected Angioplasty versus Carotid Endarterectomy trial, 2 and 9.6% in the EVA-3S [endarterectomy versus stenting in patients with symptomatic severe carotid stenosis] study 1 ).…”

Current concepts of mechanical cerebral protection during precutaneous carotid intervention

“…The mean number and the maximum size of the particles released during lter passage, those that were missed, and those that were captured by the lter device were 3.1 mm and 500 mm, 2.8 mm and 360 mm and 20 mm and 1100 mm, respectively. The majority of particles, speciVascular Medicine 2003; 8: [25][26][27][28][29][30][31][32] cally those of large size, however, were released during angioplasty/stenting and the lter captured 88% of these.…”