TY - JOUR
T1 - Technical Limitations of Carotid Filter Embolic Protection Devices
AU - Eskandari, Mark K.
AU - Najjar, Samer F.
AU - Matsumura, Jon S.
AU - Kibbe, Melina R.
AU - Morasch, Mark D.
PY - 2007/7/1
Y1 - 2007/7/1
N2 - Improved carotid artery stenting (CAS) results are credited to the development of embolic protection devices (EPDs). Reported are outcomes and technical failures of two classes of EPDs: distal balloon occlusion and distal filtration. We present a retrospective review of 206 CAS procedures from April 2001-September 2005. Filters (AccuNet, Angioguard, Filterwire, or Emboshield) were used in 98 cases (48%), distal balloon occlusion (PercuSurge) in 94 (46%), and no protection in 14. Data include demographics and procedural records. Mean age was 70 years (76% men, 24% women). At 30 days, there were no deaths, no myocardial infarctions, two major ipsilateral strokes (1%), two minor posterior strokes (1%), four transient ischemic attacks (2%), and one major access site complication (0.5%). Major neurologic events were equally divided between balloon occlusion and filters. Mean balloon occlusion time was 12 min, with only two patients (2%) manifesting reversible neurologic intolerance during flow arrest. In the last 100 cases, filter devices were preferentially used due to preserved antegrade flow. However, 11 cases (11%) necessitated intraoperative switching to balloon occlusion because of either extreme tortuosity or severe stenosis of the target lesion precluding passage of the filter element. CAS-specific equipment has improved procedural results. Despite theoretic advantages of filter EPDs, up to 10% of lesions are either too narrow or tortuous to allow safe passage of the filter element. Switching to a distal balloon occlusion system, which is well tolerated, may be preferred to unprotected predilation. Practitioners of CAS should be versed in both.
AB - Improved carotid artery stenting (CAS) results are credited to the development of embolic protection devices (EPDs). Reported are outcomes and technical failures of two classes of EPDs: distal balloon occlusion and distal filtration. We present a retrospective review of 206 CAS procedures from April 2001-September 2005. Filters (AccuNet, Angioguard, Filterwire, or Emboshield) were used in 98 cases (48%), distal balloon occlusion (PercuSurge) in 94 (46%), and no protection in 14. Data include demographics and procedural records. Mean age was 70 years (76% men, 24% women). At 30 days, there were no deaths, no myocardial infarctions, two major ipsilateral strokes (1%), two minor posterior strokes (1%), four transient ischemic attacks (2%), and one major access site complication (0.5%). Major neurologic events were equally divided between balloon occlusion and filters. Mean balloon occlusion time was 12 min, with only two patients (2%) manifesting reversible neurologic intolerance during flow arrest. In the last 100 cases, filter devices were preferentially used due to preserved antegrade flow. However, 11 cases (11%) necessitated intraoperative switching to balloon occlusion because of either extreme tortuosity or severe stenosis of the target lesion precluding passage of the filter element. CAS-specific equipment has improved procedural results. Despite theoretic advantages of filter EPDs, up to 10% of lesions are either too narrow or tortuous to allow safe passage of the filter element. Switching to a distal balloon occlusion system, which is well tolerated, may be preferred to unprotected predilation. Practitioners of CAS should be versed in both.
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U2 - 10.1016/j.avsg.2006.07.005
DO - 10.1016/j.avsg.2006.07.005
M3 - Article
C2 - 17368834
AN - SCOPUS:34447099457
SN - 0890-5096
VL - 21
SP - 403
EP - 407
JO - Annals of vascular surgery
JF - Annals of vascular surgery
IS - 4
ER -