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Usefulness of dual protection combined with blood aspiration for distal embolic protection during carotid artery stenting

  • Clinical Article - Vascular
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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.

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References

  1. Bijuklic K, Wandler A, Hazizi F, Schofer J (2012) The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 59:1383–1389

    Article  PubMed  Google Scholar 

  2. Brewster LP, Beaulieu R, Corriere MA, Veeraswamy R, Niazi KA, Robertson G, Dodson TF, Kasirajan K (2011) Carotid revascularization outcomes comparing distal filters, flow reversal, and endarterectomy. J Vasc Surg 54:1000–1004

    Article  PubMed  Google Scholar 

  3. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, Investigators CREST (2010) Stenting versus endarterectomy for treatment of carotidartery stenosis. N Engl J Med 362:11–23

    Article  Google Scholar 

  4. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ (2011) 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Neurointerventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 57:1002–10144

    Article  PubMed  Google Scholar 

  5. Harada K, Kakumoto K, Morioka J, Saito T, Fukuyama K (2014) Combination of flow reversal and distal filter for cerebral protection during carotid artery stenting. Ann Vasc Surg 28:651–658

    Article  PubMed  Google Scholar 

  6. Milosevic ZV, Kocijancic IJ, Bunc M, Bajrović FF, Zvan B (2007) Dual cerebral protection technique during carotid stenting. J Endovasc Ther 14:86–90

    Article  PubMed  Google Scholar 

  7. Montorsi P, Caputi L, Galli S, Ciceri E, Ballerini G, Agrifoglio M, Ravagnani P, Trabattoni D, Pontone G, Fabbiocchi F, Loaldi A, Parati E, Andreini D, Veglia F, Bartorelli AL (2011) Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58:1656–1663

    Article  PubMed  Google Scholar 

  8. Parodi JC, La Mura R, Ferreira LM, Mendez MV, Cersósimo H, Schönholz C, Garelli G (2000) Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 32:1127–1136

    Article  CAS  PubMed  Google Scholar 

  9. Parodi JC, Schönholz C, Ferreira LM, Mendaro E, Ohki T (2002) “Seat belt and air bag” technique for cerebral protection during carotid stenting. J Endovasc Ther 9:20–24

    Article  PubMed  Google Scholar 

  10. Sakamoto S, Kiura Y, Kajihara Y, Shibukawa M, Okazaki T, Matsushige T, Shinagawa K, Mukada K, Kurisu K (2013) Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery. Neurosurg Rev 36:551–557

    Article  PubMed  Google Scholar 

  11. Sorimachi T, Nishino K, Shimbo J, Morita K, Ito Y, Fujii Y (2010) Routine use of debris aspiration before retrieval of distal filter protection devices in carotid arterial stenting: analysis of captured debris and evaluation of clinical results. Neurosurgery 67:1260–1267

    Article  PubMed  Google Scholar 

  12. Sorimachi T, Nishino K, Morita K, Takeuchi S, Ito Y, Fujii Y (2011) Blood flow changes caused by distal filter protection and catheter aspiration in the internal carotid artery during carotid stenting: evaluation using carotid Doppler sonography. AJNR Am J Neuroradiol 32:288–293

    Article  CAS  PubMed  Google Scholar 

  13. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Shigeyuki Sakamoto, Yoshihiro Kiura, Takahito Okazaki, Katsuhiro Shinagawa, Nobuhiko Ichinose & Kaoru Kurisu

  2. Department of Neurosurgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan

    Masaaki Shibukawa, Yoji Orita & Koji Shimonaga

  3. Department of Neurosurgery, Itsukaichi Memorial Hospital, 1-95 Kurashige, Saeki-ku, Hiroshima, 731-5156, Japan

    Yosuke Kajihara

Authors
  1. Shigeyuki Sakamoto
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  2. Yoshihiro Kiura
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  3. Takahito Okazaki
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  4. Katsuhiro Shinagawa
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  5. Nobuhiko Ichinose
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  6. Masaaki Shibukawa
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  7. Yoji Orita
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  8. Koji Shimonaga
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  9. Yosuke Kajihara
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  10. Kaoru Kurisu
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Corresponding author

Correspondence to Shigeyuki Sakamoto.

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Sakamoto, S., Kiura, Y., Okazaki, T. et al. Usefulness of dual protection combined with blood aspiration for distal embolic protection during carotid artery stenting. Acta Neurochir 157, 371–377 (2015). https://doi.org/10.1007/s00701-014-2311-6

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  • DOI: https://doi.org/10.1007/s00701-014-2311-6

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