The Effect of Embolic Protection Filters on Distal Embolization and Slow Flow Condition in Carotid Artery Stenting

2007 ◽  
Author(s):  
Gail M. Siewiorek ◽  
Ender A. Finol
Keyword(s):  
Carotid Artery ◽  
Flow Rate ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
The United States ◽  
Distal Embolization ◽  
Embolic Protection ◽  
Distal Perfusion ◽  
Protection Filter

Strokes are the third leading cause of death in the United States today. Carotid artery stenting (CAS) used in conjunction with a cerebral protection device (CPD) is a current alternative treatment for severe carotid artery disease. A type of CPD, an embolic protection filter (EPF), has received attention recently due to its allowance of distal perfusion during use. This investigation studied the effects of four EPFs (Spider RX, FilterWire EZ, RX Accunet, Emboshield) on both pressure gradient and flow rate in the internal carotid artery (ICA) in vitro. Dyed polymer microspheres larger than the pore size of the devices tested were injected into the ICA of a 70% stenosed carotid artery model. The percentage of particles missed was calculated. None of the devices tested were able to completely prevent embolization. Emboshield had the least desirable performance (missing 35.4% of particles) while Spider RX had the best (missing 0.06%). A decrease in flow rate and an increase in pressure drop were seen after the device was filled with particles. From these results, it is inferred that improper wall apposition is the primary cause for inadequate capture efficiency rates, which may lead to an increase in distal embolization and stroke.

Permeability and Porosity of Embolic Protection Filters: An Experimental Study

2008 ◽  
Author(s):  
Gail M. Siewiorek ◽  
Ender A. Finol
Keyword(s):  
Carotid Artery ◽  
Flow Rate ◽  
Optimization Approach ◽  
Embolic Protection ◽  
High Resolution Images ◽  
Computational Fluid Dynamics Simulations ◽  
Protection Devices ◽  
Distal Perfusion ◽  
Dynamics Simulations

Endovascular therapies are an evolving form of treatment for stenosed atherosclerotic blood vessels. In particular, stenting and angioplasty of the carotid artery has recently gained more attention. Due to risk of periprocedural distal embolization, cerebral protection devices such as embolic protection filters (EPFs), which maintain distal perfusion during the intervention, have been developed to capture embolized plaque particles. This investigation studied in vitro the effects of a deployed EPF on flow rate in the internal carotid artery. The pseudopermeability of each device was calculated by maintaining a constant pressure gradient during its deployed state and after injection of emboli by adjusting the flow rate. High resolution images were used to calculate the porosity of each device. Experimentally-determined permeability and porosity can be used in computational fluid dynamics simulations as a design optimization approach to determine the optimal pore size for each EPF.

scholarly journals Percutaneous Treatment of Carotid Artery Stenoses with Stents: A Single Center Experience

Acta Medica ◽  
2019 ◽  
Vol 50 (3) ◽  
pp. 44-49
Author(s):  
Ahmet Hakan Ateş ◽  
Aysu Başak Özbalcı ◽  
Selim Kul ◽  
Mustafa Yenerçağ ◽  
Yusuf Ziya Şener ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Air Embolism ◽  
Percutaneous Treatment ◽  
Complication Rates ◽  
Single Center ◽  
Embolic Protection ◽  
Single Center Experience ◽  
Asymptomatic Patients

Objectives The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated in many studies. In this study, we aimed to present the characteristics and post-procedural clinical outcomes of the patients admitted to our clinic with severe carotid artery disease and revascularized by carotid artery stenting (CAS) with distal embolic protection system.   Methods This study was a single- center retrospective study. Between Jan 2015 and May 2017 patients undergoing CAS procedure were included in the study. Symptomatic cases with more than 50% stenosis and asymptomatic patients with more than 70% stenosis were included in the study. Results Twenty-five patients were included in the study. 68% of patients were male with a mean age of 69.3 ± 15.7 years. 92% of patients were symptomatic. In all patients, distal embolic protection devices and self-expandable carotid stents were used. All procedures were performed successfully. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. Five complications were seen related to the procedure. One patient had air embolism, one patient had transient ischemic attack, one patient had stroke, one patient had symptomatic nodal rhythm and the last patient had hyper-perfusion syndrome. Conclusion CAS is being successfully applied with acceptable complication rates in experienced centers.

scholarly journals Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

2013 ◽  
Vol 6 (3) ◽  
pp. 311-316 ◽  
Author(s):  
Klaudija Bijuklic ◽  
Andreas Wandler ◽  
Yuriy Varnakov ◽  
Thilo Tuebler ◽  
Joachim Schofer
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Embolic Protection ◽  
Cerebral Embolization

scholarly journals PS56. Impact of Distal Protection Filter Design in Thirty-Day Outcomes of Carotid Artery Stenting

2012 ◽  
Vol 55 (6) ◽  
pp. 42S-43S
Author(s):  
Natasha Loghmanpour ◽  
Gail Siewiorek ◽  
Kelly Wanamaker ◽  
Mark Wholey ◽  
Rabih Chaer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Filter Design ◽  
Distal Protection ◽  
Protection Filter

Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christine Hawkes ◽  
Aviraj Deshmukh ◽  
Brian van Adel
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Atheromatous Plaque ◽  
Stroke Rate ◽  
Protection Device ◽  
Single Centre ◽  
Stent Occlusion ◽  
Embolic Protection Device ◽  
Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

2021 ◽  
Author(s):  
James Hu ◽  
◽  
Andy Sohn ◽  
Justin George ◽  
Rajesh Malik ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Surgical Management ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Cerebrovascular Accidents ◽  
Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

scholarly journals CRT-300.04 Comparison of Devices in Carotid Artery Stenting: A Vascular Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic Protection Devices

2017 ◽  
Vol 10 (3) ◽  
pp. S41
Author(s):  
Ashwat S. Dhillon ◽  
Sisi Li ◽  
Juan Pablo Lewinger ◽  
Leonardo C. Clavijo ◽  
David M. Shavelle ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Embolic Protection ◽  
Protection Devices

Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system

2018 ◽  
Vol 11 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Erasmia Broussalis ◽  
Christoph Griessenauer ◽  
Sebastian Mutzenbach ◽  
Slaven Pikija ◽  
Hendrik Jansen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Antiplatelet Agents ◽  
Protection Device ◽  
Median Length ◽  
Distal Embolization ◽  
Stent System ◽  
Single Operator ◽  
Excellent Functional Outcome

IntroductionDespite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.ObjectiveTo evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement.MethodsPatients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator.ResultsA total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0–1) in 95.9% (93/97).ConclusionCarotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.

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