title: Association between plaque echogenicity and embolic material captured in filter during protected carotid angioplasty and stenting.
abstract: OBJECTIVE
  The aim of the study was to investigate debris captured in filter embolic protection devices (EPDs) during carotid artery stenting (CAS) and its possible correlation with plaque echogenicity and other risk factors.
  
  
  METHODS
  Between June 2010 and March 2011, 51 consecutive CAS patients (11 females, mean age 71.2 ± 7, 10 symptomatic) who underwent 53 procedures were included in this prospective study. Ultrasonographic Gray-Weale plaque type (I-V, echolucent to echogenic) characterisation was obtained in all cases. The same type of stent and filter EPD was used. Filters were collected and, after macroscopic evaluation, they were examined using the Thin-Prep(®) liquid-based cytology (LBC) technique.
  
  
  RESULTS
  Technical success was 100%. Thirty-day stroke and death rates were 1.8% (1/53) and 0%, respectively. Visible debris was detected in eight (15%) filters, whereas LBC revealed the presence of embolic material particles in 30 filters (56.6%). The presence of embolic material into the filter EPD was 2.38-fold increased for every category change from type IV to type I carotid plaques (OR = 2.38, 95%CI = 1.15-4.93). This association remained robust even after adjustment for age, gender and known atherosclerotic disease risk factors (OR = 2.26, 95%CI = 1.02-5.02). In multivariate analysis for risk factors, hypertension was associated with increased presence of embolic material detection in filter EPD (OR = 20.4, 95%CI = 1.28-326.1). The time distance from symptom to CAS was inversely correlated with debris quantity in EPD (Spearman rho -0.716; p = 0.02).
  
  
  CONCLUSIONS
  Echolucent plaques, smaller time frame from last symptom and hypertension were associated with increased presence of embolic material.
authors.affiliation: Department of Vascular Surgery, University of Athens Medical School, Attikon University Hospital, 1 Rimini Street, Athens, Greece. t.g.giannakopoulos@gmail.com
authors.forename: T G
authors.initials: TG
authors.lastname: Giannakopoulos
authors.forename: K
authors.initials: K
authors.lastname: Moulakakis
authors.forename: G S
authors.initials: GS
authors.lastname: Sfyroeras
authors.forename: E D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: C N
authors.initials: CN
authors.lastname: Antonopoulos
authors.forename: J D
authors.initials: JD
authors.lastname: Kakisis
authors.forename: P
authors.initials: P
authors.lastname: Karakitsos
authors.forename: E N
authors.initials: EN
authors.lastname: Brountzos
authors.forename: C D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D057505:Embolic Protection Devices; D004617:Embolism / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006115:Greece; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography