Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

Piñero, Pilar; González, Anna; Martínez, E.; Mayol, Antonio; Rafel, E.; González-Marcos, J R; Moniche, Francisco; Cayuela, Aurelio; Gil-Peralta, A

doi:10.3174/ajnr.a1407

Cited by 22 publications

(23 citation statements)

References 33 publications

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“…6) When debris was observed under a stereoscopic microscope, no unstained plaques were present. The main components of plaques (e.g., fibrin, platelets, collagen, smooth muscle, and capillary blood vessels) 7) may be stained, but calcium masses containing little protein components and cholesterol present in the superficial layer of plaque masses are not stained well. Moreover, plaques captured and visible on the filter were only solid and larger than the strut size (40 µm).…”

Section: Discussionmentioning

confidence: 99%

Pyoktanin Blue Method for Staining Fractured Plaques

Nishido

Hoya

Kugasawa

et al. 2016

JNET

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Objective: To improve the safety of carotid artery stenting (CAS), reducing the risk of perioperative ischemic complications is mandatory. To achieve this, embolic protection devices (EPD) are being used in the majority of the procedure. With the GuardWire Temporary Occlusion and Aspiration System EPD, complete evacuation of the plaque debris before deflating the occlusion balloon is important to avoid cerebral thromboembolism. We report a novel method to stain the debris on the filter device to enhance the visualization of the retrieved debris so as to facilitate complete removal of the thromboembolic source. Case Presentations:The filter devices were immersed with 0.5 ml of 1% pyoktanin solution for 5 s and irrigated with saline during the CAS procedure. The pre-stained and stained filters were compared for the visibility of the debris. The pyoktanin staining enhanced the visualization of minute debris captured on the filter that was not well recognized before the staining. Conclusion:This simple technique was effective in improving the visualization of the evacuated plaque debris and may decrease distal embolism caused by previously unrecognized debris.

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Section: Discussionmentioning

confidence: 99%

Pyoktanin Blue Method for Staining Fractured Plaques

Nishido

Hoya

Kugasawa

et al. 2016

JNET

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“…4 The presence of fibrin and platelets, foam macrophages, cellular debris, amorphous material, and cholesterol crystals is associated with a larger volume of captured material. Fibrin and platelets comprise 64% of the particulate material when the volume of embolic material is >1 mm 3 but only 33.5% when the volume of embolic material is 1 mm.…”

mentioning

confidence: 99%

“…Fibrin and platelets comprise 64% of the particulate material when the volume of embolic material is >1 mm 3 but only 33.5% when the volume of embolic material is 1 mm. 3,4 An analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke revealed a fibrin-rich distal portion and an erythrocyte-rich zone on the proximal part of the thrombi. 5 Due to blood stasis, additional postocclusion clots form in the distal end of the thromboembolic material that further increase the size of the thromboemboli.…”

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confidence: 99%

Thrombolysis May Reduce the Incidence/Extent of Postprocedural Ischemic Strokes Associated With Carotid Artery Stenting

Paraskevas

Veith

2014

Angiology

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“…2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg).…”

mentioning

confidence: 99%

“…10 Every pass of a device through an atherosclerotic stenosis generates distal emboli. 2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg). 27 Some major centers now rarely perform prestent balloon angioplasty, deliberately undersize poststent angioplasty balloons, or completely omit poststent angioplasty to decrease the potential for embolic events and hemodynamic depression.…”

mentioning

confidence: 99%

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Pelz¹,

Lownie²,

Lee³

et al. 2015

JNS

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C arotid angioplasty and stenting (CAS) has evolved into an alternative to carotid endarterectomy (CEA) for the treatment of atherosclerotic carotid stenosis, particularly since the publication of the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) in 2010. 4 In the CREST, as in most other randomized controlled trials and large case series, the standard technical protocols include the use of embolic protection devices (EPDs), self-expanding stents (SESs), and balloons preand postdilation. It has, however, been shown that EPDs do not catch all debris generated by balloons and that these expensive devices may cause complications themselves. 10Every pass of a device through an atherosclerotic stenosis generates distal emboli.2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg).27 Some major centers now rarely perform prestent balloon angioplasty, deliberately undersize poststent abbreviatioNs CAS = carotid angioplasty and stenting; CEA = carotid endarterectomy; CREST = Carotid Revascularization Endarterectomy versus Stent Trial; CTA = CT angiography; EPD = embolic protection device; NASCET = North American Symptomatic Carotid Endarterectomy Trial; PCS = primary carotid stenting; PLAC = Predicting Long-term outcome with Angioplasty of the Carotid artery; PSV = peak systolic velocity; SES = self-expanding stent. obJect Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting. methods One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4. results The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low ca...

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Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

Cited by 22 publications

References 33 publications

Pyoktanin Blue Method for Staining Fractured Plaques

Pyoktanin Blue Method for Staining Fractured Plaques

Thrombolysis May Reduce the Incidence/Extent of Postprocedural Ischemic Strokes Associated With Carotid Artery Stenting

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

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