Treatment outcomes of carotid artery stenting with two types of distal protection filter device

Abstract

PurposePreventing cerebral embolism from debris produced during carotid artery stenting (CAS) is important. This study compared the treatment outcomes of CAS using two types of filter-based embolic protection devices currently in use in Japan.Materials and methodsWe assessed 121 consecutive cases of CAS performed with FilterWire EZ™ between July 2010 and November 2012 and 37 consecutive cases of CAS performed with the Spider FX™ between November 2012 and June 2013. A Carotid Wallstent™ was used in all cases. The incidence of positive lesions on diffusion-weighted magnetic resonance imaging (DWI) and stroke were compared between the groups.ResultsPostoperative DWI-positive lesions were observed in 38 (31.4%) and 14 (37.8%) patients in the FilterWire and Spider groups, respectively. In the FilterWire group, complications were transient ischemic attacks in 3 (2.5%) patients, cerebral infarction in 2 (1.7%) patients (1 patient each with minor and major stroke), and cerebral hemorrhage due to hyperperfusion syndrome in 1 (0.8%) patient. In the Spider group, except for cerebral infarction (minor stroke) in 1 (2.7%) patient, no complications were observed. No significant differences were observed in the incidence of complications between the groups.ConclusionFilterWire EZ and Spider FX are comparable in terms of treatment outcome.

Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis

“…Table 1 shows that when comparing CEA and CAS, the frequency of ICH in the context of CHS in large studies was higher after CAS, ranging from 0.28% to 4.05%. (1, 7,9,19,30,39,42,47,49,55,57,65) In CEA varied from 0% to 2.15%. (2,5,9,10,13,16,18,20,23,29,34,(43)(44)(45), 47, 61) Also, 73% of the studies involving CAS had a frequency of ICH in the context of CHS above 0.5%.…”

“…(2,5,9,10,13,16,18,20,23,29,34,(43)(44)(45), 47, 61) Also, 73% of the studies involving CAS had a frequency of ICH in the context of CHS above 0.5%. (1, 7,9,19,30,39,42,47,49,55,57,65) In CEA, these frequencies occurred in only 26% of the cases. (2, 5, 9, 10, 13, 16, 18, 20, 23, 29, 34, 43-45, 47, 61) The "ICH to CHS proportion" has higher after CAS in comparison to CES: 7 out of 11 CAS studies (63.6%) had 50% or more hemorrhagic CHS (range 0-100%).…”

“…Eighteen studies (44%) defined both CHS and ICH at methods section. (1, 2, 7-9,16,19,20,22,24,29,34, 42,44,46, 47,61,65) The frequency of ICH after carotid intervention in studies with less than 100 participants ranged from 0% to 4.44% (4,8,14,17,18,. 21,22,24,40,46, 48,64) In studies with 101 to 1000 participants the range was from 0% to 2.21%.…”

“…21,22,24,40,46, 48,64) In studies with 101 to 1000 participants the range was from 0% to 2.21%. (1, 2, 5, 7, 9, 10,13,19,20, 23,29,30,34,39, 42, 43, 51,55,57,65) In studies that included 1001 or more participants a range from 0.09% to 0.6% was found (16,44,45,. 47,49, 50,52,61,63) With regard to the quality evaluation, the majority were rated as "good" (1,2,5,7,8,18,22,29,30,34, 50,65) or fair(4, 9, 10, 13, 16, 17, 19-21, 23, 24, 39, 40, 42-49, 51, 55-57, 63, 64), and three were "poor" (14,52,61).…”

Comparison of Flow Impairment during Carotid Artery Stenting Using Two Types of Eccentric Filter Embolic Protection Devices

“…Although these devices may engage the vessel wall more firmly than concentric filter EPDs, thereby providing better protection from embolization; ICA flow impairment is caused occasionally in CAS performed using filter EPD. 13,14) Iko et al 15) and Roffi et al 14) reported that the incidence of flow impairment was lower in the Spider FX than in the other filter EPD groups. However, the difference was not statistically significant because the number of patients treated using the Spider FX was relatively small.…”