title: Technical limitations of carotid filter embolic protection devices.
abstract: Improved carotid artery stenting (CAS) results are credited to the development of embolic protection devices (EPDs). Reported are outcomes and technical failures of two classes of EPDs: distal balloon occlusion and distal filtration. We present a retrospective review of 206 CAS procedures from April 2001-September 2005. Filters (AccuNet, Angioguard, Filterwire, or Emboshield) were used in 98 cases (48%), distal balloon occlusion (PercuSurge) in 94 (46%), and no protection in 14. Data include demographics and procedural records. Mean age was 70 years (76% men, 24% women). At 30 days, there were no deaths, no myocardial infarctions, two major ipsilateral strokes (1%), two minor posterior strokes (1%), four transient ischemic attacks (2%), and one major access site complication (0.5%). Major neurologic events were equally divided between balloon occlusion and filters. Mean balloon occlusion time was 12 min, with only two patients (2%) manifesting reversible neurologic intolerance during flow arrest. In the last 100 cases, filter devices were preferentially used due to preserved antegrade flow. However, 11 cases (11%) necessitated intraoperative switching to balloon occlusion because of either extreme tortuosity or severe stenosis of the target lesion precluding passage of the filter element. CAS-specific equipment has improved procedural results. Despite theoretic advantages of filter EPDs, up to 10% of lesions are either too narrow or tortuous to allow safe passage of the filter element. Switching to a distal balloon occlusion system, which is well tolerated, may be preferred to unprotected predilation. Practitioners of CAS should be versed in both.
authors: Division of Vascular Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, 201 East Huron Street, Chicago, IL 60611, USA. meskanda@nmh.org
authors: Mark K
authors: MK
authors: Eskandari
authors: Samer F
authors: SF
authors: Najjar
authors: Jon S
authors: JS
authors: Matsumura
authors: Melina R
authors: MR
authors: Kibbe
authors: Mark D
authors: MD
authors: Morasch
mesh_terms: D000368:Aged; D002341:Carotid Artery Thrombosis / Q000517:prevention & control*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D011859:Radiography; D012189:Retrospective Studies