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Routine aspiration method during filter-protected carotid stenting: histological evaluation of captured debris and predictors for debris amount.
MedLine Citation:
PMID:  21805288     Owner:  NLM     Status:  Publisher    
BACKGROUND: A routine aspiration method in filter-protected carotid artery stenting (CAS) has been reported recently in which the proximal internal carotid artery (ICA) blood column was aspirated using an aspiration catheter after postdilatation regardless of flow state on digital subtraction angiography. We examined the debris particles captured by this method. METHODS: The routine aspiration method was used in 71 CAS procedures. In two procedures, captured debris particles were examined histologically. In the remaining 69 procedures, the size and number of debris particles were measured under a stereoscopic microscope, and then relationships between the amount of debris particles and clinical variables were evaluated using multivariate regression analysis. RESULTS: Histologically, the captured debris contained platelet-precipitating, thrombotic, lipid-rich fibrous and calcified material. The number of debris particles ≥1 mm was 19.6 ± 12.1 (mean ± SD) in 60 procedures with normal flow and 25.9 ± 17.2 (mean ± SD) in 9 procedures with slow/stop flow. Multivariate regression analysis demonstrated that extension of a proximal ICA angulation was an independent predictor of the amount of debris particles with a maximum diameter of either ≥1 mm or <1 mm but ≥0.5 mm (p < 0.05). CONCLUSIONS: The captured debris appeared to originate from atheromatous plaques. If the routine aspiration method had not been used in the present series, the debris might have migrated into intracerebral arteries. Restriction of the extension of a proximal ICA angulation might reduce the amount of debris associated with CAS, especially when the proximal ICA angulation is pronounced.
Takatoshi Sorimachi; Akiyoshi Kakita; Kenichi Morita; Kazuhiko Nishino; Osamu Sasaki; Tetsuo Koike; Takashi Kumagai; Yasushi Ito; Yukihiko Fujii
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-31
Journal Detail:
Title:  Acta neurochirurgica     Volume:  -     ISSN:  0942-0940     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-8-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8585, Japan,
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