Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on November 27, 2008
doi: 10.3174/ajnr.A1407

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1407v1 30/3/473    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Piñero, P. Articles by Gil-Peralta, A. Search for Related Content PubMed PubMed Citation Articles by Piñero, P. Articles by Gil-Peralta, A.

American Journal of Neuroradiology 30:473-478, March 2009
© 2009 American Society of Neuroradiology

INTERVENTIONAL

Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

P. Piñero^a, A. González^b, E. Martínez^f, A. Mayol^b, E. Rafel^d, J.R. González-Marcos^c, F. Moniche^c, A. Cayuela^e and A. Gil-Peralta^c

^a Departments of Diagnostic Neuroradiology, Virgen del Rocio University Hospitals, Seville, Spain
^b Departments of Interventional Neuroradiology, Virgen del Rocio University Hospitals, Seville, Spain
^c Departments of Neurology, Virgen del Rocio University Hospitals, Seville, Spain
^d Departments of Pathology, Virgen del Rocio University Hospitals, Seville, Spain
^e Departments of Medical Records, Virgen del Rocio University Hospitals, Seville, Spain
^f Department of Neurology, Infanta Elena Hospital, Huelva, Spain

Please address correspondence to Pilar Piñero, PhD, Calle Gerardo Diego, n°9, portal 1, 2°D, Seville 41013, Spain; e-mail: pilarpingo{at}telefonica.net

BACKGROUND AND PURPOSE: Periprocedural microembolization is a major and permanent risk for patients treated by angioplasty and stent placement of high-grade carotid stenoses. Little is known however about the characteristics and significance of these embolized particles. Our aim was to assess the volume and composition of debris captured by filters during carotid angioplasty and stent placement (CAS) of severe internal carotid artery (ICA) stenoses.

MATERIALS AND METHODS: Institutional review board approval and informed consent from all subjects were obtained. Two hundred one patients (mean age, 66.2 years; range, 35–82 years) with 70% stenosis of the ICA underwent filter-protected CAS. Ultrastructural and semiquantitative analysis of the volume of filters was obtained. Multifactorial statistical analysis was performed to determine factors related to debris volume and composition.

RESULTS: Transient ischemic attack occurred in 6 patients (3%), and a major stroke, in 1 (0.5%). Debris was found in 117 filters (58.2%), with volume <1 (0.001 mL) in 71%. The number of balloon dilations, age older than 65 years, and calcified plaques in pre-CAS angiography were significantly associated with the presence of particulates inside the filters (P < .03, P < .004, and P < .05, respectively).

CONCLUSIONS: Vessel wall and atheromatous plaques are the main source of microemboli during CAS. Embolization is mainly related to the number of balloon dilations during CAS. Planning a proper and individualized strategy for the procedure in each patient is essential to minimize the potential effects of manipulation during CAS.