Circulation. 2001;104:12-15
doi: 10.1161/hc2601.092495
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
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
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]
|
|