| Technical limitations of carotid filter embolic protection devices. | |
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MedLine Citation:
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PMID: 17368834 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Mark K Eskandari; Samer F Najjar; Jon S Matsumura; Melina R Kibbe; Mark D Morasch |
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Publication Detail:
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Type: Journal Article Date: 2007-03-26 |
Journal Detail:
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Title: Annals of vascular surgery Volume: 21 ISSN: 0890-5096 ISO Abbreviation: Ann Vasc Surg Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-07-13 Completed Date: 2007-09-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 403-7 Citation Subset: IM |
Affiliation:
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Division of Vascular Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, 201 East Huron Street, Chicago, IL 60611, USA. meskanda@nmh.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Balloon Dilatation Carotid Artery Thrombosis / prevention & control* Carotid Artery, Internal Carotid Stenosis / radiography, therapy Female Humans Male Prostheses and Implants* Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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