doi: 10.1161/hs0202.102337
(Stroke. 2002;33:456.)
© 2002 American Heart Association, Inc.
Original Contributions |
Cerebral Protection During Carotid Artery Stenting
Collection and Histopathologic Analysis of Embolized Debris
From the Department of Pathology, University of Padua Medical School (A.A., M.D.B., M.V., G.T.), and Cardiology Department, Mirano Hospital, Mirano (Venice) (B.R., S.S., G.P., C.C., P.P.), Italy.
Correspondence to Gaetano Thiene, MD, FESC, Department of Pathology, University of Padua Medical School, Via A. Gabelli 61, 35121 Padua, Italy. E-mail cardpath{at}unipd.it
Background and Purpose— Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation.
Methods— Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1±11.1%). Mean age of the patients was 70.7±7.7 years; 75% were men, and 50% of patients had previous neurological symptoms.
Results— In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area of the polyurethane membrane filter covered with material was 53.2±19.8%. Particle size ranged from 1.08 to 5043.5 µm (mean, 289.5±512 µm) in the major axis and 0.7 to 1175.3 µm (mean, 119.7±186.7 µm) in the minor axis. Collected debris consisted predominantly of thrombotic material, foam cells, and cholesterol clefts.
Conclusions— By the use of distal protection filters during carotid artery stenting, it was possible to collect particulate debris potentially leading to distal vessel occlusion in a high percentage of cases. Qualitative analysis of embolized material showed debris dislocated during the percutaneous intervention from atheromatous plaques.
Key Words: angioplasty • carotid arteries • embolism • pathology • stents
This article has been cited by other articles:
 |
|
 |
|
  J. A. Bittl Damage Control for Renal Artery Stenting Circulation, May 27, 2008; 117(21): 2724 - 2726. [Full Text] [PDF]
|
|
|
|
 |
|
 E. I. Levy, J. Mocco, R. M. Samuelson, R. D. Ecker, B. S. Jahromi, and L. N. Hopkins Optimal treatment of carotid artery disease. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 979 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Samuelson, J. Yamamoto, E. I. Levy, A. H. Siddiqui, and L. N. Hopkins The Argument to Support Broader Application of Extracranial Carotid Artery Stent Technology Circulation, October 2, 2007; 116(14): 1602 - 1610. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Angelini, M. Della Barbera, and G. Thiene Interventional procedures for atherothrombosis: pathology of retrieved material Heart, October 1, 2007; 93(10): 1301 - 1308. [Full Text] [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]
|
|
|
|
 |
|
 H. D. Aronow, M. Shishehbor, D. A. Davis, I. L. Katzan, D. L. Bhatt, C. T. Bajzer, A. Abou-Chebl, K. W. Derk, P. L. Whitlow, and J. S. Yadav Leukocyte Count Predicts Microembolic Doppler Signals During Carotid Stenting: A Link Between Inflammation and Embolization Stroke, September 1, 2005; 36(9): 1910 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 B. E. Cil, E. Akpinar, B. Peynircioglu, and S. Cekirge Utility of Covered Stents for Extracranial Internal Carotid Artery Stenosis AJNR Am. J. Neuroradiol., August 1, 2004; 25(7): 1168 - 1171. [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]
|
|
|
|
|
|
J. D. Barr, J. J. Connors III, D. Sacks, J. C. Wojak, G. J. Becker, J. F. Cardella, B. Chopko, J. E. Dion, A. J. Fox, R. T. Higashida, et al. Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement: Developed by a Collaborative Panel of the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, and the Society of Interventional Radiology AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2020 - 2034. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Kopp, S. Steiner, C. Nasel, D. Seidinger, I. Mlekusch, W. Lang, A. Bartok, R. Ahmadi, and E. Minar Abciximab Reduces Monocyte Tissue Factor in Carotid Angioplasty and Stenting Stroke, November 1, 2003; 34(11): 2560 - 2567. [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]
|
|
|
|
 |
|
 J. E. Scoble Do protection devices have a role in renal angioplasty and stent placement? Nephrol. Dial. Transplant., September 1, 2003; 18(9): 1700 - 1703. [Full Text] [PDF]
|
|
|
|
|
|
F. Liistro and C. Di Mario Carotid artery stenting Heart, August 1, 2003; 89(8): 944 - 948. [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]
|
|
|
|
|
|
G. S. Roubin Angioplasty and Stenting Should Not Be Restricted to Clinical Trials Stroke, October 1, 2002; 33(10): 2520 - 2522. [Full Text] [PDF]
|
|