Endovascular treatment of internal carotid artery stenosis: effect of primary stent application on debris particle release in human cadaveric specimens.
OBJECTIVE
To compare debris release with primary stent application (self-expanding stent application at stenosis and then balloon dilation through the opened stent) and that with secondary stent application (balloon angioplasty of stenosis and afterward additional stent application) for high-grade internal carotid artery stenosis in human cadaveric specimens.


METHODS
Fresh human cadaveric internal carotid artery specimens were attached to a tube system. High-grade stenoses (>66%) were selected, randomized for primary or secondary stent application, and then treated, with fluoroscopic guidance, while the system was rinsed in a pulsating flow. Fluid was collected and filtered, and debris particles were examined with a light microscope. Particles were analyzed according to those consecutively caught by 100 x 100-microm and 11 x 11-microm mesh filters. Results were evaluated in relation to stent application. For statistical analyses of group differences, the exact Mann-Whitney U test was used.


RESULTS
Thirteen high-grade human cadaveric internal carotid artery stenoses were analyzed. Five specimens were randomly assigned to secondary stent application, and eight were assigned to primary stent application. No significant difference could be demonstrated for debris release with primary or secondary stent application. P values ranged from.051 to.754.


CONCLUSIONS
The reported superiority of primary stent application may not be related to debris reduction.
Wittkugel
Oliver
O
Department of Neuroradiology and Institute for Pathology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. wittkuge@uke.uni-hamburg.de
Fiehler
Jens
J
Koch
Christoph
C
Eckert
Bernd
B
Kilic
Ergin
E
Frahm
Mathias
M
Zeumer
Herrmann
H
D001161:Arteriosclerosis / Q000628:therapy; D002102:Cadaver; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000628:therapy*; D006801:Humans; D011897:Random Allocation; D015607:Stents