Predictors of antegrade flow at internal carotid artery during carotid artery stenting with proximal protection
Carotid artery stenting (CAS) with proximal occlusion effectively prevent distal cerebral embolism by flow arrest at internal carotid artery (ICA); however, the method can expose antegrade flow at ICA due to incomplete flow arrest. The aim of this study was to identify predictors of antegrade flow during CAS with proximal protection.
We retrospectively analyzed clinical and angiographic data among 143 lesions treated with CAS with proximal protection by occluding the common carotid artery (CCA) and external carotid artery (ECA). Flow arrest or antegrade flow at ICA was confirmed by contrast injection during proximal protection.
Antegrade flow at ICA was observed in 12 lesions (8.4%). Compared with lesions in which flow arrest of ICA was achieved, the diameter of the superior thyroid artery (STA) was significantly larger (2.4 ± 0.34 vs. 1.4 ± 0.68 mm, p < 0.001), and the rate of ECA branches other than the STA located 0–10 mm above the bifurcation was significantly higher (50 vs. 8.4%, p < 0.001). Results of multivariate analysis revealed that a diameter of the STA ≥ 2.3 mm (OR 44, 95% CI 8.1–237; p < 0.001) and ECA branches other than the STA located 0–10 mm above the bifurcation (OR 6.0, 95% CI 1.1–32; p = 0.036) were independent predictors of antegrade flow.
Distal filter protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.
KeywordsCarotid artery stenting Proximal protection Incomplete flow arrest Superior thyroid artery
Carotid artery stenting
Internal carotid artery
Common carotid artery
External carotid artery
Superior thyroid artery
Embolic protection device
Magnetic resonance imaging
Relative signal intensity
Compliance with ethical standards
Conflict of interest
For this type of study, formal consent is not required.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 2.Cassese S, Ndrepepa G, King LA, Nerad M, Schunkert H, Kastrati A, Ott I, FUsaro M (2015) Proximal occlusion versus distal filter for cerebral protection during carotid stenting: updated meta-analysis of randomised and observational MRI studies. EuroIntervention 11:238–246CrossRefPubMedGoogle Scholar
- 5.Giugliano G, Stabile E, Biamino G, Petroni G, Sannino A, Brevetti L, Pucciarelli A, Popusoi G, Tesorio T, Cioppa A, Cota L, Salemme L, Sorropago A, Ausania A, Pietra GD, Fontanelli A, Trimarco B, Esposito G, Bubino P (2014) Predictors of carotid occlusion intolerance during proximal protected carotid arterystenting. JACC Cardiovasc Interv 7:1237–1244CrossRefPubMedGoogle Scholar
- 12.Omran J, Mahmud E, White CJ, Aronow HD, Drachman DE, Gray W, Abdullah O, Abu-Fadel M, Firwana B, Mishkel G, Al-Dadah AS (2017) Proximal balloon occlusion versus distal filter protection in carotid artery stenting: a meta-analysis and review of the literature. Catheter Cardiovasc Interv 89:923–931CrossRefPubMedGoogle Scholar
- 14.Stabile E, Sannino A, Schiattarella GG, Gargiulo G, Toscano E, Brevetti L, Scudiero F, Gingliano G, Perrino C, Trimarco B, Esposito G (2014) Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion. JACC Cardiovasc Interv 7:1177–1183CrossRefPubMedGoogle Scholar