title: Routine aspiration method during filter-protected carotid stenting: histological evaluation of captured debris and predictors for debris amount.
abstract: BACKGROUND
  A routine aspiration method in filter-protected carotid artery stenting (CAS) has been reported recently in which the proximal internal carotid artery (ICA) blood column was aspirated using an aspiration catheter after postdilatation regardless of flow state on digital subtraction angiography. We examined the debris particles captured by this method.
  
  
  METHODS
  The routine aspiration method was used in 71 CAS procedures. In two procedures, captured debris particles were examined histologically. In the remaining 69 procedures, the size and number of debris particles were measured under a stereoscopic microscope, and then relationships between the amount of debris particles and clinical variables were evaluated using multivariate regression analysis.
  
  
  RESULTS
  Histologically, the captured debris contained platelet-precipitating, thrombotic, lipid-rich fibrous and calcified material. The number of debris particles ≥1 mm was 19.6 ± 12.1 (mean ± SD) in 60 procedures with normal flow and 25.9 ± 17.2 (mean ± SD) in 9 procedures with slow/stop flow. Multivariate regression analysis demonstrated that extension of a proximal ICA angulation was an independent predictor of the amount of debris particles with a maximum diameter of either ≥1 mm or <1 mm but ≥0.5 mm (p < 0.05).
  
  
  CONCLUSIONS
  The captured debris appeared to originate from atheromatous plaques. If the routine aspiration method had not been used in the present series, the debris might have migrated into intracerebral arteries. Restriction of the extension of a proximal ICA angulation might reduce the amount of debris associated with CAS, especially when the proximal ICA angulation is pronounced.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, University of Niigata, Asahimachidori, Chuo-ku, Japan. sorimachi@bri.niigata-u.ac.jp
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Sorimachi
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kakita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Morita
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nishino
authors.forename: Osamu
authors.initials: O
authors.lastname: Sasaki
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Koike
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumagai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ito
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D057505:Embolic Protection Devices / Q000592:standards; D005260:Female; D005374:Filtration / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000592:standards*; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome