Impact of Cerebral Protection Devices on Early Outcome of Carotid Stenting

Castriota, Fausto; Cremonesi, Alberto; Manetti, R; Liso, Armando; Oshola, Kareem; Ricci, E.; Balestra, G

doi:10.1177/152660280200900611

Cited by 48 publications

(19 citation statements)

References 17 publications

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“…In several studies which were largely performed without the use of any cerebral protection, stroke occurred in over 10% of patients7,14,18). Recently, EPDs have been more routinely used during CAS, and thromboembolic complications have been significantly reduced5,11). The clinical efficacy and safety of EPDs are still controversial, however, due to an increased risk of arterial vasospasm, thrombosis, and dissection4).…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

Kwon

Cheong

Lee

et al. 2013

J Korean Neurosurg Soc

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ObjectiveThe introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events.MethodsA total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group.ResultsThirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS.ConclusionIn patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.

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Section: Discussionmentioning

confidence: 99%

“…The introduction of the embolic protecting device (EPD) has resulted in a decreased rate of ischemic stroke after CAS5). Recently, however, several reports failed to show a benefit of using an EPD during CAS for reducing ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

Kwon

Cheong

Lee

et al. 2013

J Korean Neurosurg Soc

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“…In order to reduce embolic stroke during CAS procedures, an embolic protection device (EPD) has been advocated for use [7, 8]. The use of an EPD adds to manipulation and hence apart from adding to the cost, it increases procedural risks [9].…”

Section: Introductionmentioning

confidence: 99%

Carotid Revascularization with and without the Use of an Embolic Protection Device: A Single-Center Experience from Pakistan

Bashir

Baig

2018

Intervent Neurol

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Background: To assess the safety and clinical efficacy of carotid artery stenting with and without an embolic protection device (EPD) in both symptomatic and asymptomatic carotid disease cases. Methods: Retrospective data of 55 symptomatic (≥50% occlusion by digital subtraction angiography [DSA], ≥70% by ultrasound, computed tomography angiography [CTA], and magnetic resonance angiography [MRA]) and asymptomatic (≥60% by DSA, ≥70% by ultrasound, ≥80% by CTA and MRA) carotid disease cases undergoing carotid stenting/angioplasty revascularization from February 2014 to October 2017 was reviewed. All symptomatic patients either experienced recurrent transient ischemic attacks or one or more stroke attacks. An EPD protocol was designed for its selective use based on plaque morphologies and working diameters. The primary end points at 30 days of follow-up were a periprocedural incidence of any stroke, myocardial infarction or death, and ipsilateral stroke during the follow-up period. Results: Of the 55 cases, 39 were males and 16 females; mean age was 64.8 years. Fifty-one patients (92.7%) were symptomatic, with a mean stenosis of 80.1%. EPD was used in only 11 cases (20%). Minor stroke rate during the first 30 postoperative days was 1.8% (1 case) with EPD; no myocardial infarction or mortality. No stroke occurred during the median 1.5 years’ follow-up. Conclusion: Based on our single-center experience and findings of a relatively small sample size, carotid revascularization with stenting and angioplasty without EPD in experienced hands was found to be safe and efficacious. In addition, it proves cost-effective for patients by limiting the use of unnecessary disposables. These results are comparable to those reported in major trials and are well within the complication thresholds suggested in current guidelines. These results also show promise and illustrate the need for a larger, randomized controlled trial in order to thoroughly address this aspect of carotid revascularization.

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“…It has been recognized that cerebral emboli can result in subtle cognitive dysfunction that may be overlooked by commonly-performed outcome measures. Several devices have been developed to reduce or detect emboli that may be dislodged14, 15, 9, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

Assembly of a Multichannel Video System to Simultaneously Record Cerebral Emboli With Cerebral Imaging

Stoner-Duncan¹,

Kim²,

Mergeche³

et al. 2011

Journal of Neurosurgical Anesthesiology

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Stroke remains a significant risk of carotid revascularization for atherosclerotic disease. Emboli generated at the time of treatment either using endarterectomy or stent-angioplasty may progress with blood flow and lodge in brain arteries. Recently, the use of protection devices to trap emboli created at the time of revascularization has helped to establish a role for stent-supported angioplasty compared with endarterectomy. Several devices have been developed to reduce or detect emboli that may be dislodged during carotid artery stenting (CAS) to treat carotid artery stenosis. A significant challenge in assessing the efficacy of these devices is precisely determining when emboli are dislodged in real-time. To address this challenge, we devised a method of simultaneously recording fluoroscopic images, transcranial Doppler (TCD) data, vital signs, and digital video of the patient/physician. This method permits accurate causative analysis and allows procedural events to be precisely correlated to embolic events in real-time.

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Impact of Cerebral Protection Devices on Early Outcome of Carotid Stenting

Cited by 48 publications

References 17 publications

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

Carotid Revascularization with and without the Use of an Embolic Protection Device: A Single-Center Experience from Pakistan

Assembly of a Multichannel Video System to Simultaneously Record Cerebral Emboli With Cerebral Imaging

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