title: The role of embolic protection devices during carotid stenting prior to cardiac surgery in asymptomatic patients: empty filters?
abstract: OBJECTIVE
  The purpose of this study was to analyze the debris captured in the distal protection filters used during carotid artery stenting (CAS).
  
  
  BACKGROUND
  CAS is an option available to high-risk patients requiring revascularization. Filters are suggested for optimal stroke prevention during CAS.
  
  
  METHODS
  From May 2005 to June 2007, filters from 59 asymptomatic patients who underwent CAS were collected and sent to a specialized laboratory for light-microscope and histological analysis. Peri- and postprocedural outcomes were assessed during 1-year follow-up.
  
  
  RESULTS
  On the basis of biomedical imaging of the filter debris, the captured material could not be identified as embolized particles from the carotid plaque. On histological analysis the debris consisted mainly of red blood cell aggregates and/ or platelets, occasionally accompanied by granulocytes. We found no consistent histological evidence of embolized particles originating from atherosclerotic plaques. Post-procedure, three neurological events were reported: two (3.4%) transient ischemic attacks (TIA) and one (1.7%) ipsilateral minor stroke.
  
  
  CONCLUSIONS
  The filters used during CAS in asymptomatic patients planned for cardiac surgery often remained empty. These findings may be explained by assuming that asymptomatic patients feature a different atherosclerotic plaque composition or stabilization through antiplatelet medication. Larger, randomized trials are clearly warranted, especially in the asymptomatic population.
authors.affiliation: Department of Interventional Cardiology, St-Antonius Hospital, Nieuwegein, The Netherlands. janenvan@hotmail.com
authors.forename: Jan
authors.initials: J
authors.lastname: Van der Heyden
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Wolters
authors.forename: Nathalie
authors.initials: N
authors.lastname: Garin
authors.forename: Snezana Andrejevic
authors.initials: SA
authors.lastname: Blant
authors.forename: Marc
authors.initials: M
authors.lastname: Inglin
authors.forename: E T
authors.initials: ET
authors.lastname: Bal
authors.forename: Jan-Maarten
authors.initials: JM
authors.lastname: Suttorp
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D057505:Embolic Protection Devices; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D018617:Ultrasonography, Doppler, Pulsed; D017585:Ultrasonography, Doppler, Transcranial