The role of embolic protection devices during carotid stenting prior to cardiac surgery in asymptomatic patients: empty filters?

Catheter Cardiovasc Interv. 2012 Jul 1;80(1):112-9. doi: 10.1002/ccd.23383. Epub 2012 Jan 12.

Abstract

Objectives: The purpose of this study was to analyze the debris captured in the distal protection filters used during carotid artery stenting (CAS).

Background: CAS is an option available to high-risk patients requiring revascularization. Filters are suggested for optimal stroke prevention during CAS.

Methods: From May 2005 to June 2007, filters from 59 asymptomatic patients who underwent CAS were collected and sent to a specialized laboratory for light-microscope and histological analysis. Peri- and postprocedural outcomes were assessed during 1-year follow-up.

Results: On the basis of biomedical imaging of the filter debris, the captured material could not be identified as embolized particles from the carotid plaque. On histological analysis the debris consisted mainly of red blood cell aggregates and/ or platelets, occasionally accompanied by granulocytes. We found no consistent histological evidence of embolized particles originating from atherosclerotic plaques. Post-procedure, three neurological events were reported: two (3.4%) transient ischemic attacks (TIA) and one (1.7%) ipsilateral minor stroke.

Conclusion: The filters used during CAS in asymptomatic patients planned for cardiac surgery often remained empty. These findings may be explained by assuming that asymptomatic patients feature a different atherosclerotic plaque composition or stabilization through antiplatelet medication. Larger, randomized trials are clearly warranted, especially in the asymptomatic population.

MeSH terms

  • Aged
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Asymptomatic Diseases
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / therapy*
  • Coronary Artery Bypass* / adverse effects
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / surgery*
  • Embolic Protection Devices*
  • Embolism / diagnosis
  • Embolism / etiology
  • Embolism / prevention & control*
  • Female
  • Humans
  • Ischemic Attack, Transient / etiology
  • Ischemic Attack, Transient / prevention & control
  • Male
  • Middle Aged
  • Prosthesis Design
  • Severity of Illness Index
  • Stents*
  • Stroke / etiology
  • Stroke / prevention & control
  • Switzerland
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Pulsed
  • Ultrasonography, Doppler, Transcranial