Role of Activated Clotting Times in Carotid Stenting with Filter Protection

Abstract

to evaluate the role of anticoagulation therapy in carotid stenting with filter devices, we compared the activated clotting times (aCt) to angiographic filter patency and to the materials found inside the filters.29 endovascular treatments with filter cerebral protection in 27 patients affected by symptomatic internal carotid stenosis > 70% were considered. angiographic findings, aCt and histopathologic specimens were recorded and statistically correlated.Satisfactory dilatation of the stenosis was always achieved with a complication rate of 3%. during the procedure nine filters caused temporary flow impairment. histopathologic examination demonstrated material inside the filters in 86% of cases but this material was fibrin alone in 38% and plaque debris in 48%. Significant statistical correlation (p = 0.009) was found between low activated clotting time and occlusion of the filter. distal protection filters can collect plaque fragments occurring during carotid stenting. a significant proportion of the debris found in the filters consisted of thrombotic material. monitoring of heparin anticoagulation is recommended to prevent filter occlusion.

No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac Arterial Procedures

“…21,26,29,31,32,34e36 In the other 13 studies, different brands of ACT device were used. In only six of these 13 studies 23,28,30,37,39,40 information was provided on the specific model of the ACT device, and only three studies 22,39,40 provided information on the type of assays used for the ACT measurements.…”

“…Sixteen studies 24,27e41 offered details about pre-procedural anticoagulation therapy, and five studies 27,29,30,33,35 about post-procedural anticoagulation therapy. In 12 studies, 27,29,30,32e37,39e41 the pre-procedural anticoagulants or antiplatelet aggregating agents were continued.…”

“…Studies not primarily designed to define the optimal ACT. Seven studies 21,22,30,31,37,39,40 were not primarily designed to define the optimal ACT during NCAP. However, the periprocedural ACT could be correlated with clinical events of haemorrhagic complications and/or ATEC.…”

“…Castellan et al 30 included 27 patients who underwent CAS and evaluated the role of anticoagulation therapy during CAS while using filter devices. ACT values < 380 s were associated with filter occlusion in 66% of cases (6/9).…”

“…ACT values < 380 s were associated with filter occlusion in 66% of cases (6/9). 30 Shammas et al 31 included 114 patients who underwent PTA. In hospital clinical events occurred in 12 patients (9.2%).…”