Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis

Ohki, Takao; Roubin, Gary S.; Veith, Frank J.; Iyer, Sriram S.; Brady, Eamon

doi:10.1016/s0741-5214(99)70041-8

Cited by 193 publications

(131 citation statements)

References 30 publications

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“…However, the risk of passage of debris through the filter has been reported if the debris is smaller than the pore size of the filter or is liquid, or if a gap opens between the filter and vascular wall. [23][24][25] According to the literature, the DWI positive rate after CAS varied considerably (12.9%-87.1%), 26,27) and multiple factors including the plaque characteristics and stent type in addition to the protection method are considered to be involved. However, no consensus has been reached as to which of the five EPDs available today should be used in which patients, and the decision is left to each institution.…”

Section: Resultsmentioning

confidence: 99%

Appropriate Selection of CAS or CEA and Proper Use of Protection Device in the Event of CAS According to Carotid Plaque Characteristics

Sawada

Yasokawa

Mizutani

2016

JNET

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Objective: To assess the selection of carotid endarterectomy (CEA) or carotid artery stenting (CAS) and the choice of embolic protection device (EPD) on the basis of a preoperative magnetic resonance (MR) plaque image such as Sp/Sm (signal intensity ratio of carotid plaque against sternocleidomastoid muscle). Methods:Between August 2011 and August 2015, 180 patients who underwent CEA or CAS at our institution were retrospectively analyzed. CEA was selected when soft plaque was suspected by a plaque image of Sp/Sm ≥2, in contrast, CAS was indicated for patients with a surgically high-risk condition and for patients with a plaque image of Sp/Sm <2.Moreover, EPD was chosen by means of the plaque characterization such as Angioguard XP for Sp/Sm <2, Filter wire EZ or Spider FX for 2 ≤ Sp/Sm <3, and balloon (GuardWire PS/Mo.Ma Ultra) for 3 ≤ Sp/Sm. Then, we compared the peri-operative complication rate and hyperintensity rate on diffusion-weighted image (DWI) post-operatively. Results:In 80 cases with 3 ≤ Sp/Sm, CEA was performed for 30 cases and CAS using balloon for 50 cases. In 88 cases with 2 ≤ Sp/Sm <3, CEA was performed for nine cases and CAS using Filter wire EZ or Spider FX for 79 cases. The residual 12 cases with Sp/Sm <2 were treated with CAS using Angioguard XP. The complication rate was 2.1% in CAS and 0% in CEA. Asymptomatic hyperintensities on DWI after revascularization were detected in 24% of CAS patients and 0% of CEA patients. As for EPD, 27 of 79 CAS patients treated with Filter wire EZ or Spider FX had hyperintensities on DWI and hyperintensities were mostly observed in 21 of 39 patients with 2 ≤ Sp/Sm <3 on both T1-and T2-weighted imaging, but not in 6 of 40 patients with 2≤ Sp/Sm <3 on either T1-or T2-weighted imaging. Conclusion:The clinical outcome of patients treated with CEA was acceptable regardless of their carotid plaque components, if SAPPHIRE CEA high-risk group is accurately excluded. Considering that balloon protection should be used as EPD against soft plaque with 2 ≤ Sp/Sm <3 on both T1-and T2-weighted imaging, selection of CEA or CAS and EPD based on the MR plaque characteristics such as Sp/Sm is a useful strategy.

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Section: Resultsmentioning

confidence: 99%

Appropriate Selection of CAS or CEA and Proper Use of Protection Device in the Event of CAS According to Carotid Plaque Characteristics

Sawada

Yasokawa

Mizutani

2016

JNET

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“…Tirofiban, a glicoprotein IIa-IIIb blocker was used in severe cases (irregular lesions, smoking patients). In one patients with pos surgical restenosis Abciximab was utilized (19). Carotid doppler ultrasound follow-up was obtained until 6 months after procedure.…”

Section: Methodsmentioning

confidence: 99%

“…Cerebral protection with filter devices during carotid artery stenting has been recently shown better results [15][16][17][18][19] .…”

mentioning

confidence: 99%

“…The filter protection mechanism allows red blood cells flow, blocking only higher than 100 micra particules. Stenotic lesions can be treated even if severe contralateral disease is present 18,19 . This study objective is to describe our experience in the percutaneous endovascular treatment of internal carotid artery stenosis with angioplasty and stenting with and without cerebral protection devices.…”

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confidence: 99%

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Endovascular treatment of carotid artery stenosis: retrospective study of 79 patients treated with stenting and angioplasty with and without cerebral protection devices

Kihara

Andrioli

Zukerman

et al. 2004

Arq. Neuro-Psiquiatr.

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-We evaluate the results of stenting and angioplasty on carotid bifurcation stenotic lesions using protection systems, emphasizing the indications and technical aspects. Seventy-nine patients, mean age 64.5 years were treated from February,1998 to March, 2003. All patients were included in NASCET study criteria. Forty three patients were treated without the protection systems and thirty six were treated with carotid protection filtering system (Angioguard, EPI). Technical success and 6-months carotid Doppler ultrasound follow-up showing stent patency were achieved in all patients. One major stroke and one death due to intracranial reperfusion bleeding occurred in patients treated without cerebral protection devices. Only one patient presenting hyper perfusion syndrome improving after 7 days, was found in the group treated with the cerebral protection filter mechanism, no other neurologic symptom or death occured in this group. Stenting and angioplasty with protection systems for thromboembolic debris is a safe endovascular method to treat stenotic lesions in the carotid bifurcation with low morbidity and mortality.KEY WORDS: carotid artery stent, carotid artery atherosclerosis, endovascular therapy.Tratamento endovascular das lesões estenóticas em bifurcação carotídea: estudo retrospectivo de 79 pacientes tratados por "stent" e angioplastia com e sem mecanismos de proteção cerebral RESUMO -Este estudo mostra a experiência e resultados da terapêutica endovascular nas lesões estenóti-cas em bifurcação carotídea. Entre fevereiro de 1998 e março de 2003 foram tratados 79 pacientes com idades entre 57 e 72 anos (média 64,5 anos) sendo 45 do masculino e 34 do feminino. Todos os pacientes enquadravam-se nos critérios do estudo "NASCET" com comprometimento das artérias carótidas internas. Dos 79 pacientes, 43 foram tratados sem os sistemas de proteção e 36 pacientes foram tratados com sistema de proteção. Dos 36 pacientes tratados com sistema de proteção foram utilizados filtros de proteção (Angioguard e EPI). Observou-se melhora angiográfica em todos os 79 pacientes tratados. Ultrasom Doppler realizado após 6 meses mostrou artérias pérvias em todos os pacientes. Nos 43 pacientes tratados por "stent"/angioplastia sem a utilização de sistemas de proteção tivemos um paciente com déficit neurológi-co que perdurou por mais de 30 dias ("stroke major") e um óbito por transformação hemorrágica devido à reperfusão. Ocorreu síndrome de hiperperfusão em 1 paciente dos 36 pacientes tratados com o sistema de proteção, regredindo em 7 dias, sendo que nos demais não houve morbi-mortalidade. A angioplastia e "stent" no território carotídeo com a utilização de sistema de proteção é um método seguro com reduzida morbidade e mortalidade estando indicada nas lesões estenóticas das bifurcações carotídeas. PALAVRAS-CHAVE: stent artéria carotída, aterosclerose carotídea, terapêutica endovascular.

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“…Embolic protection devices (EPDs) have the function of catching the plaque material and keeping it during the intervention. As shown in Figure 1, they are placed distal to the stent in the internal carotid artery (ICA) [14]. Although the use of EPDs during CAS intuitively suggests advantages, there is no clinical randomized trial showing a statistical meaningful difference [10].…”

Section: Introductionmentioning

confidence: 99%

Efficiency test of current carotid embolic protection devices

Kurzhals

Matthies

Andresen

et al. 2017

Biomedical Engineering / Biomedizinische Technik

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Embolic protection devices were developed to reduce the risk of stroke during carotid artery stenting. The aim of this study was to test the capture efficiency of five embolic protection devices under reproducible in vitro conditions. The setup consisted of silicone tubes representing the vessel modeling round and oval cross sections. Spherical polystyrene particles (150 μm, COOH-coating) were used to simulate the plaque. The particles were inserted in a clean water circuit and either captured by the device or collected in a glass filter. The missed particles were counted by laser obscuration as a measure of device leakage. The systems Angioguard RX, RX Accunet, FiberNet, FilterWire EZ and EmboshieldNAV were analyzed. At the round cross section, FilterWire EZ demonstrated the highest capture efficiency (0% of missed particles) and RX Accunet the lowest, at 34%. The amount of leaked particles increased to 22% for FilterWire EZ and 89% for Angioguard RX during the test with the oval cross profile.

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Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis

Abstract: These study results show that this filter device, at least in this model, did not add complexity to the interventional procedure itself. Furthermore, the filter may markedly decrease embolic events during carotid PTAS and expand the indications for this procedure.

Cited by 193 publications

References 30 publications

Appropriate Selection of CAS or CEA and Proper Use of Protection Device in the Event of CAS According to Carotid Plaque Characteristics

Appropriate Selection of CAS or CEA and Proper Use of Protection Device in the Event of CAS According to Carotid Plaque Characteristics

Endovascular treatment of carotid artery stenosis: retrospective study of 79 patients treated with stenting and angioplasty with and without cerebral protection devices

Efficiency test of current carotid embolic protection devices

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