Treatment outcomes of carotid artery stenting with two types of distal protection filter device

Introduction : Prevention of distal embolization during carotid artery stenting (CAS) is a key element of procedural technique and is standardly performed using distal protection devices (DPDs). Data in support of DPDs, however, are limited. Here, we present our experience of proximal occlusion using a balloon guide catheter (BGC) during CAS as the primary method of distal embolic protection. Methods : We conducted a retrospective review of patients undergoing CAS at our healthcare system between January of 2018 to March of 2021. Procedures were categorized by embolic protection strategy: DPD or BGC (with or without DPD). Emergent cases were defined as patients receiving CAS within <24 hours of presenting with an ischemic stroke or TIA ipsilateral to the carotid disease side. Severe stenosis was defined as 70–99% per NASCET criteria. The primary outcome was rate of procedural ischemic stroke between the DPD and BGC groups, and was defined as acute focal neurological deficit lasting for ≥ 24 hours following CAS related to an embolic event during the procedure. Results : A total of 126 CAS procedures were performed during the study period. 91 cases were performed under proximal BGC protection (of which 24 also included DPD usage) and 35 CAS cases via DPD as a primary mean for embolic protection. The median age for the cohort was 68 [IQR 62‐76], 37% females, 31% (n = 39) cases were treated emergently, and elective cases were 69% (n = 87). Baseline characteristics were similar in both groups except for hyperlipidemia (BGC vs DPD, 71.4% vs 42.9%; p = 0.003) and history of smoking (BGC vs DPD, 56% vs 34.4%; p = 0.029). Severe carotid stenosis was present in 80.2% BGC group and 77.1% in DPD (p = 0.573). Post‐stenting balloon angioplasty was more frequent in the BGC group as compared with DPD (54% vs. 26%, BGC vs. DPD, p = 0.005). Procedural embolic stroke rates were low in both groups, and not significantly different (1.1% vs. 2.9%, BGC vs. DPD, p = 0.48). Conclusions : CAS with BGC as the primary means of distal embolic protection showed comparable, low rates of procedural embolic ischemic events compared to those with DPD. These findings suggest BGC embolic strategies may be a viable alternative to DPD usage.

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Abstract WP155: The Safety And Efficacy Of Carotid Artery Stenting In A High Grade Stenosis More Than 80% Under Proximal Protection With Flow-reversal System.

Stroke ◽

10.1161/str.44.suppl_1.awp155 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Rie Yako ◽

Osamu Masuo ◽

Hiroyuki Matsumoto ◽

Naoyuki Nakao ◽

Tomoaki Terada ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Reverse Flow ◽

Clinical Results ◽

High Grade ◽

Protection Device ◽

Safety And Efficacy ◽

Significant Difference ◽

Ischemic Complication ◽

Distal Protection

Background: Different embolic protection devices in carotid artery stenting(CAS) have been developed to prevent procedural cerebral embolization. Proximal flow reverse protection has theoretically advantages from the view point of prevention of distal embolism, compared with distal protection. On the other hand, there is a disadvantage that this system is complexity. Purpose: we evaluated the safety and efficacy of proximal reverse flow protection for CAS in patients with high-grade stenosis. Methods: Distal protection has mainly been used as protection device in our institute. In case that there was high possibility of distal embolism, proximal reverse flow protection has been used. These cases treated with proximal flow reverse protection were included in this study. A total of 75 patients(71 men, mean age 71.9 years) with a high grade stenosis≧80% were treated between September 2003 and March 2012. 72% (n=54) of the patients were symptomatic.The primary endpoint was death and stroke rate at 30 days. The outcome was also compared to data from 386 patients with a high-grade stenosis who were treated under only distal protection device in the same period. Results: The procedure was technically successful in all cases. In 2 cases out of proximal reverse flow protection group, intracerebral hemorrhage was occurred. However, there was no ischemic complication. In distal protection group, the incidence of complication occurred in 11 cases (7 ischemic, 4 otheres). The stroke/death rate at 30 days was 2.6% (n=2) in proximal reverse flow protection group compared to 2.8% (n=11) in the distal protection group. There was no significant difference. However, the incidence of ischemic complication in the proximal reverse flow protection group tended to be lower than that of distal protection group. Conclusion: In selected patients with large atherosclerotic plaques, the clinical results of CAS with proximal reverse flow protection is safe and feasible. Especially, the incidence of ischemic stroke was lower than that of distal protection.

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Carotid Artery Stenting with Distal Protection Using the Carotid Wallstent and Filterwire Neuroprotection: Single-Center Experience of 380 Cases with Midterm Outcomes

Vascular ◽

10.2310/6670.2006.00054 ◽

2006 ◽

Vol 14 (5) ◽

pp. 237-244 ◽

Cited By ~ 13

Author(s):

Peter H. Lin ◽

Wei Zhou ◽

Marlon A. Guerrero ◽

Sally A. McCoy ◽

Deborah Felkai ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenting ◽

Multivariable Analysis ◽

Related Complication ◽

Asymptomatic Patients ◽

Distal Protection ◽

Carotid Wallstent

Emerging data have supported the clinical efficacy of carotid artery stenting (CAS) in stroke prevention in high-risk surgical patients. This study was performed to evaluate the midterm clinical outcome of CAS using the Carotid Wallstent and FilterWire distal protection (both Boston Scientific, Natick, MA) at an academic institution. Risk factors for in-stent restenosis (ISR) were also analyzed. Clinical variables and treatment outcome of high-risk patients who underwent Carotid Wallstent placement with FilterWire EX/EZ neuroprotection were analyzed during a recent 54-month period. Three hundred eighty CAS procedures were performed in 354 patients. Technical success was achieved in 372 cases (98%), and symptomatic lesions existed in 85 (24%) patients. No patient experienced periprocedural mortality or neuroprotective device–related complication. The 30-day stroke and death rate was 2.7%, and the overall complication rate was 6.9%. The overall major or fatal stroke rates in symptomatic and asymptomatic patients were 4.6% and 1.3%, respectively (not significant). The overall stroke and death rates between the symptomatic and asymptomatic groups were 5.8% and 2.4%, respectively (not significant). The median follow-up period was 29 months (range 1–53 months). With Kaplan-Meier analysis, the rates of freedom from 60% or greater ISR after CAS procedures at 12, 24, 36, and 48 months were 97%, 94%, 92%, and 90%, respectively. The rates of freedom from all fatal and nonfatal strokes at 12, 24, 36, and 48 months were 97%, 91%, 89%, and 85%, respectively. Multivariable analysis of significant univariate predictors identified that postendarterectomy stenosis (odds ratio [OR] 3.98, p = .02) and multiple stent placement (OR 3.68, p = .03) were independent predictors of ISR. Our study yielded favorable short-term and midterm clinical results using Carotid Wallstent with FilterWire neuroprotection. Late follow-up results showed low rates of fatal and nonfatal stroke and favorable ISR rates compared with other carotid stent trials. Postendarterectomy and multiple stent placement were associated with subsequent ISR.

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