title: A manual carotid compression technique to overcome difficult filter protection device retrieval during carotid artery stenting.
abstract: BACKGROUND
  We investigated the incidence of embolic protection device retrieval difficulties at carotid artery stenting (CAS) with a closed-cell stent and demonstrated the usefulness of a manual carotid compression assist technique.
  
  
  METHODS
  Between July 2010 and October 2013, we performed 156 CAS procedures using self-expandable closed-cell stents. All procedures were performed with the aid of a filter design embolic protection device. We used FilterWire EZ in 118 procedures and SpiderFX in 38 procedures. The embolic protection device was usually retrieved by the accessory retrieval sheath after CAS. We applied a manual carotid compression technique when it was difficult to navigate the retrieval sheath through the deployed stent. We compared clinical outcomes in patients where simple retrieval was possible with patients where the manual carotid compression assisted technique was used for retrieval.
  
  
  RESULTS
  Among the 156 CAS procedures, we encountered 12 (7.7%) where embolic protection device retrieval was hampered at the proximal stent terminus. Our manual carotid compression technique overcame this difficulty without eliciting neurologic events, artery dissection, or stent deformity.
  
  
  CONCLUSIONS
  In patients undergoing closed-cell stent placement, embolic protection device retrieval difficulties may be encountered at the proximal stent terminus. Manual carotid compression assisted retrieval is an easy, readily available solution to overcome these difficulties.
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan. Electronic address: k.nii@cis.fukuoka-u.ac.jp.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Nii
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsutsumi
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikawa
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Iko
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Kimiya
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mitsutake
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Ayumu
authors.initials: A
authors.lastname: Eto
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Hayatsura
authors.initials: H
authors.lastname: Hanada
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kazekawa
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D002544:Cerebral Infarction / Q000150:complications / Q000601:surgery; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010291:Paresis / Q000209:etiology; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: Carotid artery stenting; difficult retrieval; filter protection device; manual carotid compression; proximal stent terminus