Complication with an embolic protection device during carotid angioplasty

Abstract

A case of carotid artery stenting with an AngioGuard cerebral protection device is described in a patient with tight internal carotid stenosis. Deployment of AngioGuard induced sudden severe vasospasm, with subsequent minor stroke. According to our observations, AngioGuard may cause a vasospastic response with adverse neurologic effects.

Iatrogenic vasospasm in carotid artery stent angioplasty with distal protection devices

“…Irritation or damage of the intima, ranging from self-limiting vasospasm to intimal dissection with occlusion of the vessel, can ensue acutely. 4,12,19,25 Stone et al 24 report a 0.6% rate of dissection after using the FilterWire EX DPD in 348 interventions in aortocoronary bypass grafts. Keeping the DPD stable during the intervention necessitates frequent fluoroscopic position checks that prolong the procedure.…”

Carotid Stenting without Use of Balloon Angioplasty and Distal Protection Devices: Preliminary Experience in 100 Cases

“…1,[22][23][24] Furthermore, CPD itself can cause severe spasm and dissection with subsequent minor stroke. 25,26 Other potential drawbacks of CPDs include the passage of a CPD through the stenotic lesion that entails a potential risk of dislodgement of unstable plaques, the intolerance to balloon occlusion devices in many patients who have contralateral carotid disease or absence of intracranial communicant arteries, failed deployment of the CPD or difficulty in its retrieval because of complicated anatomy, and embolus that can potentially escape during removal of the CPD. These disadvantages have led some authors to be skeptical about the value of protection devices.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…49 Device malfunction that results in deployment failure, stent malformation, and migration after deployment is rare, occurring in <1% of procedures. [245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited.…”