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Ann Vasc Surg. 2012 Oct;26(7):929-36. doi: 10.1016/j.avsg.2012.04.022.

Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and evaluation of debris capture.

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  • 1Department of Neurosurgery, Fukuoka Wajiro Hospital, Heart and Neurovascular Center, Fukuoka, Japan. keihara@f-wajirohp.jp

Abstract

BACKGROUND:

Carotid artery stenting (CAS) with distal filter protection allows for continuous cerebral perfusion. However, this procedure has been reported to be associated with a greater risk of debris migrating into the cerebral arteries. To improve the extent of debris capture, we used a guiding catheter with temporary balloon occlusion and temporary aspiration from the common carotid artery.

METHODS:

Eighty-one stenoses were treated with CAS using distal filter protection; simple distal filter protection (conventional group, n = 50) or distal filter protection with temporary proximal flow control and blood aspiration was performed using a 9-F guiding catheter with a temporary balloon occlusion positioned at the common carotid artery (proximal occlusion group, n = 31). Clinical outcomes, rates of capturing visible debris, and new ischemic signals on diffusion-weighted magnetic resonance imaging (DWI) were evaluated.

RESULTS:

Events involving procedure-related emboli causing neurological deficits occurred in 6.0% (3/50) and 3.2% (1/31) of patients in the conventional and proximal occlusion groups, respectively (P = 1.0). The rates of visible debris capture by using the distal filter were 64.0% (32/50) and 29.0% (9/31) in the convention and proximal occlusion groups, respectively, being significantly lower in the proximal occlusion group (P < 0.01). New ischemic signals on DWI were detected in 44.0% (22/50) and 12.9% (4/31) of cases in the conventional and proximal occlusion groups, respectively, being significantly lower in the proximal occlusion group (P < 0.01).

CONCLUSIONS:

Combining distal filter protection and a guiding catheter with temporary balloon occlusion in CAS significantly reduced visible debris captured by the distal filter and occurrence of small postprocedural cerebral infarctions detected by DWI.

Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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