Microscopic and macroscopic evaluation of emboli captured during angioplasty and stent procedures in extracranial vertebral and internal carotid arteries.
OBJECTIVE
To compare the quantities of emboli dislodged during percutaneous transluminal angioplasty/stenting in the vertebral artery (VA) with those released during stent placement in the internal carotid artery (ICA).


METHODS
Macroscopic images of distal protection devices (DPD) used during 30 stent procedures in 16 ICAs (11 men; mean age 64.6+/-10.6 years) and 14 VAs (9 men; mean age 67.1+/-9.8 years) were reviewed. The amount of captured embolic debris was calculated and expressed as a proportion to the size of the filter. Histological examinations were performed to characterize the material trapped in the filters.


RESULTS
Relative to the size of the filter, the proportion of captured debris ranged from 0.1% to approximately 22% in the ostial VA filters and from 0.1% to approximately 21% in the filters used in the ICA procedures (p = NS). Plaque fragments with or without thrombus were discovered in the histological examinations of captured material. There were no significant differences in the characteristics of the debris between the 2 vascular regions, nor did sex, race, or plaque morphology correlate significantly with the proportion of captured debris. However, the severity of stenosis was significantly (p<0.029) greater in the ICA (73%+/-0.11%) than the VA (63%+/-0.09%) territory.


CONCLUSIONS
The study suggests that the frequency and amount of captured emboli during stent procedures in ICA and ostial VAs are comparable. Therefore, the use of a DPD for stent placement in the vertebral artery may be advisable.
Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA. divani@umn.edu
Afshin A
AA
Divani
Tamara L
TL
Berezina
Jingying
J
Zhou
Reza
R
Pakdaman
M Fareed K
MF
Suri
Adnan I
AI
Qureshi
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology / Q000628:therapy*; D004617:Embolism / Q000150:complications / Q000209:etiology / Q000473:pathology*; D004867:Equipment Design; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D014711:Vertebral Artery / Q000473:pathology*; D014715:Vertebrobasilar Insufficiency / Q000473:pathology / Q000628:therapy*