Cerebral protection with filter devices during carotid artery stenting.
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.


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.
Reimers
B
B
Columbus Clinic, San Raffaele Hospital, Milano, Mirano, Italy.
Corvaja
N
N
Moshiri
S
S
Saccà
S
S
Albiero
R
R
Di Mario
C
C
Pascotto
P
P
Colombo
A
A
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications; D005240:Feasibility Studies; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D007022:Hypotension / Q000209:etiology; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome