The capture of visible debris by distal cerebral protection filters during carotid artery stenting: Is it predictable?
OBJECTIVE
Neurologic complications during carotid artery stenting (CAS) are most clearly associated with embolization of visible debris. Distal filter devices may provide cerebral protection by capturing clinically significant debris. However, they increase procedural time and expense and have their own set of complications. The current study was undertaken to identify the clinical factors predictive for the presence or absence of visible debris captured by distal filter devices during CAS.


METHODS
Patients undergoing CAS with use of a distal filter device (n = 279) were prospectively entered into an investigational carotid registry. Recorded variables were classified as patient-, lesion-, or procedure-related. The filter was assessed for visible debris in each case. The odds ratio (OR) and 95% confidence interval (CI) were determined for each variable to predict visible debris. The ability of each variable to predict the absence of visible debris was assessed by calculating the individual negative predictive value (NPV).


RESULTS
Visible debris was present in 169 filters (60.3%). There was an increased risk of visible debris found with several variables (OR, 95% CI): hypertension (2.9, 1.7 to 5.2), hypercholesterolemia (2.3, 1.4 to 3.9), stent diameter >9 mm (16.6, 9.0 to 30.0), and any neurologic event (4.2, 1.5 to 9.9). The NPV failed to exceed 0.80 (80%) for any variable. The NPV of the variables with a significantly elevated OR was as follows: hypertension (0.60), hypercholesterolemia (0.52), stent diameter >9 mm (0.75), and any neurologic event (0.38).


CONCLUSIONS
Several clinical variables are associated with the presence of visible debris captured by distal filter devices. The current study failed to identify any variables capable of consistently predicting the absence of visible debris. These findings support the routine rather than the selective use of cerebral protection during CAS.
Sprouse
L Richard
LR
Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. lrsii@msn.com
Peeters
Patrick
P
Bosiers
Marc
M
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D016893:Carotid Stenosis / Q000628:therapy*; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D019736:Prostheses and Implants; D015607:Stents / Q000009:adverse effects