title: Usefulness of dual protection combined with blood aspiration for distal embolic protection during carotid artery stenting.
abstract: BACKGROUND
  We describe dual protection (simultaneous flow reversal and distal filter) combined with blood aspiration as a novel technique to provide distal embolic protection during carotid artery stenting (CAS).
  
  
  METHODS
  Between July 2011 and August 2014, 190 patients with internal carotid artery (ICA) stenosis underwent 190 CAS procedures as follows. After post-dilation of the stent using dual protection, the aspiration catheter was placed between the distal filter and the proximal end of the stent, and the blood was aspirated several times from the ICA. We assessed hyper-intensity spots in diffusion-weighted images (DWI), and major adverse events (MAE) defined as major stroke, myocardial infarction and death after CAS. We then assessed visible debris captured in aspirated blood, the distal filter and a blood filter during flow reversal.
  
  
  RESULTS
  The overall technical success rate was 100 %, and all stenoses were dilated. Hyper-intense spots were found in 33 (17.3 %) of 190 DWI. The rate of MAE within 30 days was 1.05 % (2/190). Visible debris in 175 of 190 CAS procedures was captured in 92 (52.5 %) of these 175. In 25 (27.2 %) of these 92, visible debris was captured in all of aspirated blood, the distal filter and the blood filter during flow reversal, only the blood filter during flow reversal (n = 19; 20.7 %), only the distal filter (n = 14; 15.2 %), only aspirated blood (n = 11; 12 %), aspirated blood and the blood filter during flow reversal (n = 10; 10.8 %), aspirated blood and the distal filter (n = 7; 7.6 %) and the distal filter and blood filter during flow reversal (n = 6; 6.5 %).
  
  
  CONCLUSIONS
  Adding a distal filter and blood aspiration to flow reversal during CAS could provide effective distal embolic protection.
authors.affiliation: Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, sakamoto@hiroshima-u.ac.jp.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kiura
authors.forename: Takahito
authors.initials: T
authors.lastname: Okazaki
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Shinagawa
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Ichinose
authors.forename: Masaaki
authors.initials: M
authors.lastname: Shibukawa
authors.forename: Yoji
authors.initials: Y
authors.lastname: Orita
authors.forename: Koji
authors.initials: K
authors.lastname: Shimonaga
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kajihara
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery*; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods