Catheter aspiration thrombectomy during carotid stenting is safe and potentially efficacious: a pilot retrospective study.
OBJECTIVE
Despite distal embolic protection (DEP) during carotid artery stenting (CAS), there is still an appreciable risk of stroke, especially in symptomatic patients and octogenerians. The mechanism of embolic events is possibly related to microembolization of debris remaining on or forming on stent struts. We evaluated the safety of using aspiration thrombectomy after CAS.


METHODS
Between August 2006 and July 2010, 80 symptomatic and asymptomatic patients with severe carotid artery stenosis (>80%) underwent CAS utilizing DEP. After completion of CAS and before removal of DEP, an aspiration catheter was passed through the CAS segment. Both extracted volume and the DEP were visually examined. The primary endpoint was stroke and death at 30 days. These patients were divided into two groups, Group 1 (N=7) comprised those who had aspiration thrombectomy to treat no-flow or an acute neurologic change that occurred during CAS. Group 2 (N=73) comprised patients that underwent prophylactic aspiration thrombectomy. Outcomes were then compared to a control group (N=925) who had CAS with DEP, but without aspiration thrombectomy.


RESULTS
Moderate to large amounts of debris were extracted from the CAS segment in the majority of thrombectomy patients (90%). There was one death (1%) and one stroke (1%) in the thrombectomy groups, while the control group had 3.0% rate of death and stroke (P=0.83).


CONCLUSIONS
Aspiration thrombectomy recovers large to moderate amounts of debris and is safe and does not increase adverse periprocedural events. A large scale, randomized trial with magnetic resonance imaging (MRI) is needed to further investigate our findings.
Texas Heart Institute at St Lukes Episcopal Hospital, Huston, TX, USA. zvonkomd@aol. com
B
B
Shabaneh
K
K
Dougherty
E
E
Hernandez
N
N
Strickman
Z
Z
Krajcer
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057785:Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013396:Suction; D013781:Texas; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome