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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 December;21(4):344-8

language: English

Microembolization during carotid stenting with the distal-balloon antiemboli system

Al-Mubarak N., Roubin G. S., Vitek J. J., Iyer S. S.

Endovascular Therapeutics, University Hospital System of Cleveland, Cleveland, OH, USA


Background. The dis­tal-bal­loon pro­tec­tion ­system is ­being eval­u­at­ed ­for ­its effi­ca­cy in pre­vent­ing embol­ic neu­ro­log­i­cal ­events dur­ing carot­id stent­ing (­CAS). We ­sought to deter­mine ­the ­effect of ­this ­system on ­the fre­quen­cy of ­the Doppler-detect­ed micro­em­bol­ic sig­nals (­MES) dur­ing ­CAS.
Methods. Using trans­cra­ni­al Doppler, we com­pared ­the fre­quen­cy of ­MES dur­ing ­CAS in 2 ­groups; 39 ­patients with­out dis­tal pro­tec­tion ­and 37 ­with ­the dis­tal-bal­loon pro­tec­tion ­system (GuardWire®, Percusurge, Sunnyville, CA). There ­was no sig­nif­i­cant dif­fer­ence in ­the clin­i­cal or angio­graph­ic char­ac­ter­is­tics ­between ­the 2 ­groups. Three phas­es ­with ­increased ­MES ­counts ­were iden­ti­fied dur­ing ­the unpro­tect­ed ­CAS; ­stent deploy­ment, pred­i­la­tion, ­and post­di­la­tion (­mean±SD: 75±57, 32±36, ­and 27±25, respec­tive­ly).
Results. The dis­tal-bal­loon pro­tec­tion sig­nif­i­cant­ly ­reduced ­the fre­quen­cy of ­MES dur­ing ­CAS (­MES-­counts: 164±108 in ­the con­trol vs 68±83 in ­the pro­tec­tion ­group, p=0.002) par­tic­u­lar­ly dur­ing ­these 3 phas­es. ­MES in ­the pro­tec­tion ­group ­were detect­ed pre­dom­i­nant­ly dur­ing ­sheath place­ment, guide­wire manip­u­la­tion ­and dur­ing ­the dis­tal-bal­loon defla­tion.
Conclusions. Three phas­es ­with ­increased ­MES ­counts ­were iden­ti­fied dur­ing ­the unpro­tect­ed ­CAS, e.g. ­stent deploy­ment, pred­i­la­tion ­and post­di­la­tion. The dis­tal-bal­loon pro­tec­tion ­system sig­nif­i­cant­ly ­reduced ­the fre­quen­cy of ­MES dur­ing ­CAS, par­tic­u­lar­ly dur­ing ­these 3 phas­es.

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