title: Protection filter-related events in extracranial carotid artery stenting: a single-center experience.
abstract: OBJECTIVE
  To report the complications, rescue procedures, and consequences related to the use of an embolus protection filter during carotid artery stenting (CAS).
  
  
  METHODS
  A retrospective review was undertaken of 72 patients (58 men; mean age 70.0+/-8.2 years, range 56-87) with extracranial atherosclerotic carotid stenosis who underwent 77 CAS procedures under filter protection. Filter-related events and rescue procedures according to each procedural step were retrospectively evaluated on CAS angiograms. In addition, neurological events and outcomes were also assessed.
  
  
  RESULTS
  CAS using a filter was successful in 99% of cases, and the overall rate of minor stroke (n=1), major stroke (0), or mortality (n=1) was 2.6% at 30 days. Filter placement was successful in all cases. However, arterial tortuosity made it difficult for a filter to pass through the stenosis in 1 case; this was overcome with an additional supportive wire (0.018-inch). Filter-related events were flow impairment in 6 (7.8%), filter wedging in the catheter tip in 4 (5.2%), vasospasm >50% narrowing in 7 (9.1%), filling defects within the filter membrane in 5 (6.5%), retrieval failure with the provided retriever in 3 (3.9%), and insecure retrieval without filter collapse in 2 (2.6%). Flow impairment caused drowsy mentality and impaired verbal response in 4, which resolved after prompt filter retrieval. All the cases of filter wedging were resolved with a catheter pulled down into the stented segment to separate the filter element from the catheter tip. Significant vasospasm and filling defects were spontaneously resolved in all cases after filter retrieval. Inability to pass a retriever catheter through a stent was overcome with curved 5-F catheter manipulation in all 3 cases.
  
  
  CONCLUSIONS
  The use of a filter during CAS may induce various angiographic or technical events at each step. For a severely stenotic and tortuous carotid lesion with difficult access, a filter may become trapped or irretrievable during flow arrest. Physicians should be aware of the preventive and rescue maneuvers to counter filter-related events, perhaps even considering another type of protection mechanism or carotid endarterectomy.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Seoul 110-744, Korea.
authors.forename: Bae Ju
authors.initials: BJ
authors.lastname: Kwon
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D050197:Atherosclerosis / Q000150:complications; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016894:Endarterectomy, Carotid; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014654:Vascular Patency; D020301:Vasospasm, Intracranial / Q000209:etiology
chemical_list: D000497:Alloys; C013616:nitinol