Circulation. 2001;104:12-15
doi: 10.1161/hc2601.092495
doi: 10.1161/hc2601.092495
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(Circulation. 2001;104:12.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Cerebral Protection With Filter Devices During Carotid Artery Stenting
From the Columbus Clinic (N.C., R.A., C.D.M., A.C.) and San Raffaele Hospital (S.M., C.D.M., A.C.), Milano, and the Cardiology Department, Mirano Hospital (B.R., S.S., P.P.), Mirano, Italy.
Correspondence to Antonio Colombo, MD, Centro Cuore Columbus, Via Buonarotti, 48 20145 Milano, Italy. E-mail columbus{at}micronet.it
Background—Distal embolization of debris during percutaneous carotid artery stenting may result in neurological deficit. Filter devices for cerebral protection potentially reduce the risk of embolization.
Methods and Results—Elective carotid stent implantation using 3 different types of distal filter protection devices was attempted in 88 consecutive lesions (84 patients) in the internal carotid artery that had >70% diameter stenosis (mean, 78.7±10.7%). Procedures were performed in 3 different centers. The mean age of the patients was 69±8 years, 75% were men, and 35.7% had neurological symptoms. In 86 lesions, a stent was successfully implanted (97.7%). In 83 of these 86 procedures (96.5%), it was possible to position a filter device. In 53% of filters, there was macroscopic evidence of debris. Collected material consisted of lipid-rich macrophages, fibrin material, and cholesterol clefts. Neurological complications during the procedure, in the hospital, and at 30 days of clinical follow-up occurred in only one patient (1.2%). This patient suffered a minor stroke that resolved within 1 week. Two major adverse cardiac events (2.3%) occurred during the 30 days of follow-up.
Conclusions—Filter protection during carotid artery stenting seems feasible and safe. In the present series, the incidence of neurological complications was low.
Key Words: carotid arteries • angioplasty • stents • embolism
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