doi: 10.1161/hc2601.092495
(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
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
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
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
Stent placement for extracranial carotid artery disease has emerged as a potential alternative to carotid endarterectomy.1 2 As shown by transcranial Doppler monitoring, percutaneous carotid stenting is accomplished with increased dislocation of microemboli compared with the surgical approach.3 Emboli have been associated with a higher neurological complication rate4 and are a potential cause of periprocedural stroke after endarterectomy.5 6 7 Protection devices have the potential to reduce the incidence of intracranial particulate debris embolization and render carotid artery revascularization safer.8 9 10 11 The present, prospective, multicenter registry was designed to evaluate the feasibility and safety of recently available filter protection devices.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
Patient and Lesion Characteristics
Between January 2000 and January 2001, elective carotid artery stent implantation using a distal emboli protection filter was attempted in 88 consecutive lesions in 84 patients (42 patients at Columbus Hospital, 10 at San Raffaele Hospital, 32 at Mirano Hospital). These lesions were 39.8% of the total 221 lesions treated overall in the 3 study centers. All patients presented with a significant (>70%) stenosis of the internal or common carotid artery. Clinical and angiographic characteristics are listed in Table 1
.
|
All patients were taking aspirin (100 to 325 mg). Ticlopidine (500 mg) was started at least 48 hours before the procedure, and heparin (70 to 100 U/kg) was given intra-arterially. Arterial blood pressure was monitored during the procedure and, if needed, modulated with nitrates or dopamine. All patients were awake during the procedure. After the procedure, patients received aspirin indefinitely and ticlopidine for 1 month.
Careful neurological examination, including the NIH Stroke Scale, was performed before and after the procedure, at discharge, and at 30-day follow-up by a board-certified neurologist or by a board-certified internist. In 23 cases (26%), 1-month follow-up information was obtained by telephone call. Neurological complications were previously defined by Mathur et al.12
Carotid Stenting Procedure
Procedures were performed by following a strict
protocol that was developed in collaboration by the first operators
(A.C., C.D.M., and B.R.). Percutaneous access was
gained through the femoral or brachial (2.3%) artery. Long sheaths (80
to 90 cm long; 6 or 7 French in diameter) or coronary guiding
catheters (8 French) were advanced into the common carotid artery using
diagnostic catheters and long 0.035 or 0.038 inch support
wires placed in the external carotid artery. Stenoses were
crossed with a filter device with a diameter matching the distal
cervical internal carotid artery
(Figure 1). Three different filter designs were used; they
included 48 Angioguard filters (55.8%; (J&J
Cordis), 30 NeuroShield filters (34.9%;
MedNova), and 8 FilterWire EX filters (9.3%; Embolic Protection, Inc;
Figure 2). All filters were released recently, and
data on their clinical efficacy are not available. The present
study was not designed to detect differences between filters but to
evaluate the clinical feasibility and safety of protection devices
during cardiovascular
intervention.13 After
positioning of the filter, predilation with coronary balloons
was performed in 83.7% of cases. Self-expandable stents (82.3%
Carotid Wallstent, Boston Scientific-Schneider;
12.8% X-act, MedNova; and 4.7% SMART stent,
Cordis) were implanted, and all but one stent
was postdilated at a medium-high pressure (8 to 12
atm).
|
|
Filter Device Description
The filter consists of a nitinol skeleton or
supporting wire with a polyurethane membrane that has pores with a
diameter ranging from 80 to 130 µm. The diameter of the filters
ranged from 5.0 to 7.0 mm. The filters are connected to the distal
end of a 0.014-inch wire with a floppy tip, which was used as a
guidewire during the interventional procedure. The closed filter is
advanced through the lesion and opened in the internal carotid artery
distal to the lesion. At the end of the procedure, a retrieval sheath
is advanced, and the filter is closed and removed from the
artery.
Histopathological analysis was performed on 25 filters (30.1%) by light microscopy after staining with hematoxylin-eosin and Azan-Mallory.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
In 2 lesions (2.3%), it was impossible to advance a long sheath or a coronary guiding catheter in the common carotid artery. In the remaining 86 procedures (97.7%), a stent was positioned at the lesion site. In 83 of these 86 cases (96.5%), the filter device crossed the lesion. In 6 of these cases (6.9%), the filter could be advanced through the lesion only after gentle predilation with 2.0-mm diameter coronary balloons. In 3 lesions (3.5%), the filter did not cross the stenosis. Crossing success occurred in 46 of the 48 Angioguard filters (95.8%), 29 of the 30 Neuroshield filters (96.6%), and 8 of 8 FilterWire EX filters (100%). In one case, an occlusive balloon protection system was adopted (Guardwire, Percusurge Inc), and 2 lesions (2.3%) were treated without protection. Spasm of the distal internal carotid artery, which resolved after intra-arterial nitrate administration, was observed in 3 cases (3.6%). Flow impairment resistant to nitrates, without angiographic signs of vessel spasm and resolving after filter removal, occurred in 6 procedures (7.2%). At the angiographic control vessel, alterations of the segment of the internal carotid artery where the filter was positioned were not observed. Difficult retrieval of the closed or partially closed filter through the stent requiring repeat rotation of the device occurred in 7 cases (8.4%). Macroscopic visible debris was seen in 44 filters (53%). Procedural data and results are shown in Table 2
.
|
One patient (1.2%) experienced a category 1 minor stroke with partial upper limb paralysis, which resolved completely within 1 week. Four patients (4.6%) required intravenous dopamine infusion for prolonged hypotension. There were no procedural deaths and no vascular access complications.
The 30-day clinical follow-up did not reveal any further neurological events. Two major adverse cardiac events (2.3%) occurred. One patient with severe coronary artery disease suffered a massive anterior myocardial infarction 4 days after carotid stent implantation and died 3 days later with heart failure. A second patient underwent coronary angioplasty the day before carotid stenting and experienced a nonfatal, acute Q-wave myocardial infarction from subacute stent thrombosis.
The histological analysis detected particulate, atheromatous material characterized by lipid-rich macrophages, fibrin material, and cholesterol clefts.
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
This is, to our knowledge, the largest consecutive series of carotid stent implantation using filter devices for cerebral protection. Previously reported series of cerebral protection with occlusive balloon systems report similar favorable results in terms of a low incidence of neurological complications.9 After comparing occlusive balloons with filter systems, we determined that balloons have a favorable, lower crossing profile but do not permit flow and are not tolerated by all patients. With filter devices, antegrade flow is maintained, allowing visualization and more precise stent placement (Figure 1
). In this study, filter devices were well tolerated
by all patients. The presence of particulate detected at microscopic analysis shows that filters could collect debris that otherwise would have embolized in cerebral vessels. It is impossible to postulate the clinical impact collected debris might have had. However, most complications during surgical endarterectomy have been related to the presence of distal embolism.4 5 6 The histological findings confirm earlier studies suggesting that material is dislocated from the atheromatous plaque during the intravascular procedure.8 9
The major cardiac events occurring in 2 patients (2.3%) underline the importance of considering the hemodynamic consequences of the procedure.14
Limitations of the Study
One limitation of the study is the absence of
transcranial Doppler monitoring during the stent
procedure. Therefore, the study does not provide any information on the
degree of embolization occurring while crossing the lesion with the
device, nor does it provide data on the efficiency of the filter in
capturing all particles dislocated during angioplasty and stenting. A
recent ex vivo study reported that 88% of embolized particles
were captured in the
filter.11 Whatever the
degree of Doppler-detectable embolization was, we should
acknowledge the low incidence of associated neurological
events.
In 26% of the procedures, 1-month follow-up evaluation was obtained by telephone contact only. Therefore, minor neurological events may be under-reported.
|
Conclusions |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
Cerebral protection with filter devices during carotid artery stent implantation seemed feasible and safe. Protection devices reduce the cerebral embolization of plaque debris during carotid artery stent implantation. The incidence of associated neurological events was low; however, the clinical efficacy of protection filters requires further confirmation.
Received March 23, 2001; revision received May 4, 2001; accepted May 4, 2001.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
|---|
1. Wholey MH, Wholey M, Mathias K, et al. Global experience in cervical carotid artery stent placement. Cathet Cardiovasc Interv. 2000;50:160–167.[Medline] [Order article via Infotrieve]
2.
Roubin SG, New G,
Iyer SS, et al. Immediate and late clinical outcomes of carotid artery
stenting in patients with symptomatic and
asymptomatic carotid artery stenosis: a 5-year
prospective analysis.
Circulation. 2001;103:532–537.
3. Jordan WD, Voellinger DC, Doblar DD, et al. Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc Surg. 1999;7:33–38.[Medline] [Order article via Infotrieve]
4. Markus HS, Clifton A, Buckenham T, et al. Carotid angioplasty: detection of embolic signals during and after the procedure. Stroke. 1994;25:2403–2406.[Abstract]
5.
Ackerstaff RG,
Moons KG, van de Vlasakker CJ, et al. Association of intraoperative
transcranial Doppler monitoring variables with
stroke from carotid endarterectomy.
Stroke. 2000;31:1817–1823.
6. Gaunt ME, Martin PJ, Smith JL, et al. Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: a prospective study of 100 patients. Br J Surg. 1994;81:1435–1439.[Medline] [Order article via Infotrieve]
7.
Krul JMJ, van Gijn
J, Askerstaff GA, et al. Site and pathogenesis of infarcts associated
with carotid endarterectomy.
Stroke. 1989;20:324–328.
8.
Theron JG, Payelle
GG, Coskun O, et al. Carotid artery stenosis: treatment with
protected balloon angioplasty and stent placement.
Radiology. 1996;201:627–636.
9. Henry M, Amor M, Henry I, et al. Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg. 1999;6:321–331.[Medline] [Order article via Infotrieve]
10. Albuquerque FC, Teitelbaum GP, Lavine SD, et al. Balloon-protected carotid angioplasty. Neurosurgery. 2000;46:918–921.[Medline] [Order article via Infotrieve]
11. Ohki T, Roubin GS, Veith FJ, et al. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: an ex vivo analysis. J Vasc Surg. 1999;30:1034–1044.[Medline] [Order article via Infotrieve]
12.
Mathur A, Roubin
GS, Iyer S, et al. Predictors of stroke complicating carotid artery
stenting. Circulation. 1998;97:1239–1245.
13.
Topol EJ, Yadav
JS. Recognition of the importance of embolization in atherosclerotic
vascular disease. Circulation. 2000;101:570–580.
14.
Qureshi AI, Luft
AR, Sharma M, et al. Frequency and determinants of postprocedural
hemodynamic instability after carotid angioplasty and
stenting. Stroke. 1999;30:2086–2093.
This article has been cited by other articles:
 |
|
 |
|
  B. El Oumeiri, M. Boodhwani, D. Glineur, L. De Kerchove, A. Poncelet, P. Astarci, A. Pasquet, J.-L. Vanoverschelde, R. Verhelst, J. Rubay, et al. Extending the Scope of Mitral Valve Repair in Rheumatic Disease. Ann. Thorac. Surg., June 1, 2009; 87(6): 1735 - 1740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Jansen, J. Fiehler, M. Hartmann, and H. Bruckmann Protection or Nonprotection in Carotid Stent Angioplasty: The Influence of Interventional Techniques on Outcome Data From the SPACE Trial Stroke, March 1, 2009; 40(3): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kojuri, M. A Ostovan, N. Zamiri, A. Zolghadr Asli, M. A Bani Hashemi, and A. Borhani Haghighi Procedural Outcome and Midterm Result of Carotid Stenting in High-Risk Patients Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 93 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Eskandari Preventable Complications of Carotid Stenting Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2008; 20(1): 17 - 25. [Abstract] [PDF]
|
|
|
|
 |
|
 N. Janjua, A. Alkawi, M.F.K. Suri, and A.I. Qureshi Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 253 - 258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Sacks, Y. Enomoto, J. R. Graybill, W. D. Merryman, A. Zeeshan, A. P. Yoganathan, R. J. Levy, R. C. Gorman, and J. H. Gorman III In-vivo dynamic deformation of the mitral valve anterior leaflet. Ann. Thorac. Surg., October 1, 2006; 82(4): 1369 - 1377. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S M Tuladhar and P P Punjabi Surgical reconstruction of the mitral valve Heart, October 1, 2006; 92(10): 1373 - 1377. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rucker, T. Schafer, C. Scheuer, Y. Harder, B. Vollmar, and M. D. Menger Local Heat Shock Priming Promotes Recanalization of Thromboembolized Microvasculature by Upregulation of Plasminogen Activators Arterioscler Thromb Vasc Biol, July 1, 2006; 26(7): 1632 - 1639. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S. Roubin, S. Iyer, A. Halkin, J. Vitek, and C. Brennan Realizing the Potential of Carotid Artery Stenting: Proposed Paradigms for Patient Selection and Procedural Technique Circulation, April 25, 2006; 113(16): 2021 - 2030. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.D. Hill, W. Morrish, G. Soulez, A. Nevelsteen, G. Maleux, C. Rogers, K.E. Hauptmann, A. Bonafe, R. Beyar, L. Gruberg, et al. Multicenter evaluation of a self-expanding carotid stent system with distal protection in the treatment of carotid stenosis. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 759 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Murphy, J. J. Byrne, and H. A. Malave Robotic endoscopic excision of accessory mitral leaflet J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 468 - 469. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. P. Liew and J. R Bartholomew Atheromatous embolization Vascular Medicine, November 1, 2005; 10(4): 309 - 326. [Abstract] [PDF]
|
|
|
|
 |
|
 I. P. Casserly, A. Abou-Chebl, R. B. Fathi, D. S. Lee, J. Saw, J. E. Exaire, S. R. Kapadia, C. T. Bajzer, and J. S. Yadav Slow-Flow Phenomenon During Carotid Artery Intervention With Embolic Protection Devices: Predictors and Clinical Outcome J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1466 - 1472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. I. Paraskevas, S. S. Daskalopoulou, M. E. Daskalopoulos, and C. D. Liapis Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence? Angiology, September 1, 2005; 56(5): 539 - 552. [Abstract] [PDF]
|
|
|
|
|
|
L. J. Coward, R. L. Featherstone, and M. M. Brown Safety and Efficacy of Endovascular Treatment of Carotid Artery Stenosis Compared With Carotid Endarterectomy: A Cochrane Systematic Review of the Randomized Evidence Stroke, April 1, 2005; 36(4): 905 - 911. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Sztriha, E. Voros, K. Sas, R. Szentgyorgyi, A. Pocsik, P. Barzo, P. Szikra, A. Makai, A. Szolics, P. Elek, et al. Favorable Early Outcome of Carotid Artery Stenting Without Protection Devices Stroke, December 1, 2004; 35(12): 2862 - 2866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Zahn, B. Mark, N. Niedermaier, U. Zeymer, P. Limbourg, T. Ischinger, K. Haerten, K. E. Hauptmann, E.-R. v. Leitner, W. Kasper, et al. Embolic protection devices for carotid artery stenting: better results than stenting without protection? Eur. Heart J., September 1, 2004; 25(17): 1550 - 1558. [Abstract] [Full Text]
|
|
|
|
|
|
A. Angelini, P. Rubartelli, F. Mistrorigo, M. Della Barbera, F. Abbadessa, M. Vischi, G. Thiene, and S. Chierchia Distal Protection With a Filter Device During Coronary Stenting in Patients With Stable and Unstable Angina Circulation, August 3, 2004; 110(5): 515 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Eskandari, G. M. Longo, J. D. Vijungco, M. D. Morasch, and W. H. Pearce Does Carotid Stenting Measure Up to Endarterectomy?: A Vascular Surgeon's Experience Arch Surg, July 1, 2004; 139(7): 734 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Gray A cardiologist in the carotids J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1602 - 1605. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Rogers, R. Huynh, P. A. Seifert, B. Chevalier, J. Schofer, E. R. Edelman, G. Toegel, A. Kuchela, A. Woupio, R. E. Kuntz, et al. Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris Circulation, April 13, 2004; 109(14): 1735 - 1740. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Rahimtoola The year in valvular heart disease J. Am. Coll. Cardiol., February 4, 2004; 43(3): 491 - 504. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Gorman III, B. M. Jackson, Y. Enomoto, and R. C. Gorman The effect of regional ischemia on mitral valve annular saddle shape Ann. Thorac. Surg., February 1, 2004; 77(2): 544 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Crane and N. Cheshire Recent developments in vascular surgery BMJ, October 18, 2003; 327(7420): 911 - 915. [Full Text] [PDF]
|
|
|
|
|
|
M. Schluter, T. Tubler, J. C. Steffens, D. G. Mathey, and J. Schofer Focal ischemia of the brain after neuroprotected carotid artery stenting J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1007 - 1013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Liistro and C. Di Mario Carotid artery stenting Heart, August 1, 2003; 89(8): 944 - 948. [Full Text] [PDF]
|
|
|
|
|
|
A. Cremonesi, R. Manetti, F. Setacci, C. Setacci, and F. Castriota Protected Carotid Stenting: Clinical Advantages and Complications of Embolic Protection Devices in 442 Consecutive Patients Stroke, August 1, 2003; 34(8): 1936 - 1941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kastrup, K. Groschel, H. Krapf, B. R. Brehm, J. Dichgans, and J. B. Schulz Early Outcome of Carotid Angioplasty and Stenting With and Without Cerebral Protection Devices: A Systematic Review of the Literature Stroke, March 1, 2003; 34(3): 813 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Macdonald and P. A Gaines Current concepts of mechanical cerebral protection during precutaneous carotid intervention Vascular Medicine, February 1, 2003; 8(1): 25 - 32. [Abstract] [PDF]
|
|
|
|
|
|
Z. Kaposzta, A. Clifton, J. Molloy, J. F. Martin, and H. S. Markus S-Nitrosoglutathione Reduces Asymptomatic Embolization After Carotid Angioplasty Circulation, December 10, 2002; 106(24): 3057 - 3062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Fox Jr, C. J. Moran, D. T. Cross III, R. L. Grubb Jr, K. M. Rich, M. R. Chicoine, R. G. Dacey Jr, and C. P. Derdeyn Long-Term Outcome After Angioplasty for Symptomatic Extracranial Carotid Stenosis in Poor Surgical Candidates Stroke, December 1, 2002; 33(12): 2877 - 2880. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Stone, C. Rogers, S. Ramee, C. White, R. E. Kuntz, J. J. Popma, J. George, S. Almany, and S. Bailey Distal filter protection during saphenous vein graft stenting: Technical and clinical correlates of efficacy J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1882 - 1888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Stankovic, F Liistro, S Moshiri, C Briguori, N Corvaja, G Gimelli, A Chieffo, M Montorfano, L Finci, V Spanos, et al. Carotid artery stenting in the first 100 consecutive patients: results and follow up Heart, October 1, 2002; 88(4): 381 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Roubin Angioplasty and Stenting Should Not Be Restricted to Clinical Trials Stroke, October 1, 2002; 33(10): 2520 - 2522. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Muller-Hulsbeck, J. Grimm, C. Liess, J. Hedderich, M. Bergmeyer, and M. Heller Comparison and Modification of Two Cerebral Protection Devices Used for Carotid Angioplasty: In Vitro Experiment Radiology, October 1, 2002; 225(1): 289 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schluter, T. Tubler, D. G. Mathey, and J. Schofer Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting J. Am. Coll. Cardiol., September 4, 2002; 40(5): 890 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Kochiadakis, S. I. Chrysostomakis, N. E. Igoumenidis, E. I. Skalidis, and P. E. Vardas Anomalous Collateral from the Coronary Artery to the Affected Lung in a Case of Congenital Absence of the Left Pulmonary Artery* : Effect on Coronary Circulation Chest, June 1, 2002; 121(6): 2063 - 2066. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Kaufman, W.A.J. Hoefnagels, G. S. Roubin, G. New, and R. L. Sacco Extracranial Carotid Stenosis N. Engl. J. Med., May 16, 2002; 346(20): 1590 - 1591. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Forbess, K. J. Visconti, D. C. Bellinger, R. J. Howe, and R. A. Jonas Neurodevelopmental outcomes after biventricular repair of congenital heart defects J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 631 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Al-Mubarak, A. Colombo, P. A. Gaines, S. S. Iyer, N. Corvaja, T. J. Cleveland, S. Macdonald, C. Brennan, and J. J. Vitek Multicenter evaluation of carotid artery stenting with a filter protection system J. Am. Coll. Cardiol., March 6, 2002; 39(5): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Angelini, B. Reimers, M. D. Barbera, S. Sacca, G. Pasquetto, C. Cernetti, M. Valente, P. Pascotto, and G. Thiene Cerebral Protection During Carotid Artery Stenting: Collection and Histopathologic Analysis of Embolized Debris Stroke, February 1, 2002; 33(2): 456 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ballotta, G. S. Roubin, G. New, S. S. Iyer, J. J. Vitek, N. Al-Mubarak, M. W. Liu, J. Yadav, C. Gomez, and R. E. Kuntz Immediate and Late Clinical Outcomes of Carotid Artery Stenting in Patients With Symptomatic and Asymptomatic Carotid Artery Stenosis: A 5-Year Prospective Analysis Response Circulation, November 27, 2001; 104 (22): e121 - e122. [Full Text] [PDF]
|
|
|
|
|
|
D. O. Williams Carotid Filters : New Additions to the Interventionist's Toolbox Circulation, July 3, 2001; 104(1): 2 - 3. [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||