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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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REVIEWS CEREBRAL PROTECTION IN CAROTID ARTERY STENTING
The Journal of Cardiovascular Surgery 2010 December;51(6):865-72
Catheter aspiration thrombectomy during carotid stenting is safe and potentially efficacious: a pilot retrospective study
Shabaneh B., Dougherty K., Hernandez E., Strickman N., Krajcer Z. ✉
1 Texas Heart Institute at St Lukes Episcopal Hospital, Huston, TX, USA;
2 Baylor College of Medicine, Huston, TX, USA;
3 Texas Health Science Center, Houston, TX, USA
AIM: Despite distal embolic protection (DEP) during carotid artery stenting (CAS), there is still an appreciable risk of stroke, especially in symptomatic patients and octogenerians. The mechanism of embolic events is possibly related to microembolization of debris remaining on or forming on stent struts. We evaluated the safety of using aspiration thrombectomy after CAS.
METHODS: Between August 2006 and July 2010, 80 symptomatic and asymptomatic patients with severe carotid artery stenosis (>80%) underwent CAS utilizing DEP. After completion of CAS and before removal of DEP, an aspiration catheter was passed through the CAS segment. Both extracted volume and the DEP were visually examined. The primary endpoint was stroke and death at 30 days. These patients were divided into two groups, Group 1 (N=7) comprised those who had aspiration thrombectomy to treat no-flow or an acute neurologic change that occurred during CAS. Group 2 (N=73) comprised patients that underwent prophylactic aspiration thrombectomy. Outcomes were then compared to a control group (N=925) who had CAS with DEP, but without aspiration thrombectomy.
RESULTS: Moderate to large amounts of debris were extracted from the CAS segment in the majority of thrombectomy patients (90%). There was one death (1%) and one stroke (1%) in the thrombectomy groups, while the control group had 3.0% rate of death and stroke (P=0.83).
CONCLUSION: Aspiration thrombectomy recovers large to moderate amounts of debris and is safe and does not increase adverse periprocedural events. A large scale, randomized trial with magnetic resonance imaging (MRI) is needed to further investigate our findings.