Skip to main content
SpringerLink
Log in

Embolic Containment Devices and How to Avoid Disaster

  • Chapter
Book cover Practical Carotid Artery Stenting

Abstract

Carotid artery stenting (CAS) is emerging as an alternative therapy to surgical carotid endarter-ectomy (CEA) for the treatment of extracranial carotid stenosis [1–3]. The common goal of both procedures is the prevention of stroke, and the efficacy of the procedure depends highly on the periprocedural complication rates. Despite the routine application of stents, advanced stenting techniques, and dual antiplatelet therapy, emboli-zation of debris into the cerebral circulation occurs invariably during CAS. Obstructive carotid artery lesions are known to contain friable, ulcerated, and thrombotic material [4] that can embolize during the intervention, as shown in histopathologic analysis in both ex vivo [5] and in vivo [6] studies, and also demonstrated in transcranial Doppler studies. In addition, it has been shown that microemboliza-tion occurs considerably more frequently during CAS than during CEA [7].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Roubin SG, New G, Iyer SS, et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis. A 5-year prospective analysis. Circulation 2001;103:532–7.

    Article  PubMed  CAS  Google Scholar 

  2. Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a randomised trial. Lancet 2001;357:1729–37.

    Google Scholar 

  3. Reimers B, Schlüter M, Castriota F, et al.. Routine use of cerebral protection during carotid artery stent-ing: results of a multicenter registry of 753 patients. Am J Med 2004;116:217–22.

    Article  PubMed  Google Scholar 

  4. Imparato AM, Riles TS, Gorstein F. The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia. Stroke 1979;10:238–45.

    Article  PubMed  CAS  Google Scholar 

  5. Ohki T, Roubin GS, Veith FJ, et al. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: an ex vivo analysis. J Vasc Surg 1999;30:1034–44.

    Article  PubMed  CAS  Google Scholar 

  6. Angelini A, Reimers B, Dalla Barbera M, et al. Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke 2002;33:456–61.

    Article  PubMed  Google Scholar 

  7. Crawley F, Clifton A, Buckenham T, et al. Comparison of hemodynamic cerebral ischemia and microem-bolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke 1997;28:2460–4.

    Article  PubMed  CAS  Google Scholar 

  8. Al-Mubarak N, Roubin GS, Vitek JJ, Iyer S, New G, Leon MB. Effect of the distal-balloon protection system on microembolization during carotid stent-ing. Circulation 2001;104:1999–2002.

    Article  PubMed  CAS  Google Scholar 

  9. Kastrup A, Groschel K, Krapf H, et al. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 2003;34:1936–41.

    Article  Google Scholar 

  10. Brooks WH, McClure RR, Jones MR, et al. Carotid angioplasty and stenting versus carotid endarterec-tomy: randomized trial in a community hospital. J Am Coll Cardiol 2001;38:1589–95.

    Article  PubMed  CAS  Google Scholar 

  11. Sprouse LR, II, Peeters P, Bosiers M. The capture of visible debris by distal cerebral protection filters during carotid artery stenting: is it predictable ? J Vasc Surg 2005;41:950–5.

    Article  PubMed  Google Scholar 

  12. Cremonesi A, Setacci C, Manetti R, De Donato G, Setacci F, Balestra G, Borghesi I, Bianchi P, Castriota F. Carotid angioplasty and stenting: lesion related treatment strategies. Eurointervention 2005;1:289–95.

    PubMed  Google Scholar 

  13. Zahn R, Mark B, Niedermier N, Zeymer U, Limbourg P, Ischinger T, Haerten K, Hauptmann KE, Leitner ER, Kasper W, Tebbe U, Senges J. Embolic pro-tection devices for carotid artery stenting: better results than stenting without protection ? Eur Heart J 2004;25:1550–8.

    Article  PubMed  Google Scholar 

  14. Castriota F, Cremonesi A, Manetti R, Liso A, Oshoala K, Ricci E, Balestra G. Impact of cerebral protection devices on early outcome of carotid stent-ing. J Endovasc Ther 2002;9:786–92.

    Article  PubMed  Google Scholar 

  15. Mas JL, Chatellier G, Beyssen B; EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 2004;35:e18–e20.

    PubMed  CAS  Google Scholar 

  16. Wholey MH, Al-Mubarek N, Wholey MH. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv 2003;60:259–66.

    Article  PubMed  Google Scholar 

  17. Hart JP, Peeters P, Verbist J, Deloose K, Bosiers M. Do device characteristics impact outcome in carotid artery stenting? J Vasc Surg 2006;44(4):725–30.

    Article  PubMed  Google Scholar 

  18. Mames RN, Snady-McCoy L, Guy J. Central retinal and posterior ciliary artery occlusion after particle embolization of the external carotid artery system. Ophthalmology 1991;98:527–31.

    PubMed  CAS  Google Scholar 

  19. Whitlow PL, Lylyk P, Pondero H, Mendiz OA, Mahias K, Jaeger H, Parodi J, Schönholz C, Milei J. Carotid artery stenting protected with an emboli containment system. Stroke 2002;33:1308–14.

    Article  PubMed  Google Scholar 

  20. Müller-Hülsbeck S, Stolzmann P, Liess C, Hedderich J, Paulsen F, Jahnke T, Heller M. Vessel wall damage caused by cerebral protection devices: ex vivo evaluation in porcine carotid arteries. Radiology 2005;235:454–60.

    Article  PubMed  Google Scholar 

  21. Vos JA, van den Berg JC, Ernst SM, Suttorp MJ, Overtoom TT, Mauser HW, Vogels OJ, van Hessewijk HP, Moll FL, van der Graaf Y, Mali WP, Ackerstaff RG. Carotid angioplasty and stent placement: comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 2005;234:493–9.

    Article  PubMed  Google Scholar 

  22. Parodi JC, Schönholz C, Ferreira M, Mendaro E, D'Agostino H. Parodi antiembolism system in carotid stenting: the first 100 patients. Presented at Society of Interventional Radiology 27th Annual Scientific Meeting, Baltimore, MD, 2002, April 6–11.

    Google Scholar 

  23. Adami CA, Scuro A, Spinamano L, Galvagni E, Antoniucci D, Farello G, Maglione F, Manfrini S, Mangialardi N, Mansueto G, Mascoli F, Nardelli E, Tealdi D. Use of the Parodi anti-embolism system in carotid stenting: Italian trial results. J Endovasc Ther 2002;9:147–54.

    Article  PubMed  Google Scholar 

  24. Bates MC, Molano J, Pauley ME. Internal carotid artery flow arrest/reversal cerebral protection techniques. W V Med J 2004;100:60–3.

    PubMed  Google Scholar 

  25. Parodi JC, Ferriera LM, Lamura R, Sicard G. Results of the first 200 cases of carotid stents using the ArteriA device. Presented at the International Congress of Endovascular Interventions XVII, Scottsdale, AZ, 2005, February 13–17.

    Google Scholar 

  26. Diederich KW, Scheinert D, Shmidt A, Scheinert S, Reimers B, Sievert H, Rabe K, Coppi G, Moratto R, Hoffmann FJ, Schuler GC, Biamino G. First clinical experiences with an endovascular clamping system for neuroprotection during carotid stenting. Eur J Vasc Endovasc Surg 2004;28:629–33.

    Article  PubMed  Google Scholar 

  27. Coppi G, Moratto R, Silingardi R, Rubino P, Sarropago G, Salemme L, Cremonesi A, Castriota F, Manetti R, Sacca S, Reimers B. Proximal flow blockage cerebral protection during carotid stenting (PRIAMUS). J Cardiovasc Surg 2005;46:219–27.

    CAS  Google Scholar 

  28. Schmidt A, Diederich KW, Scheinert S, Bräunlich S, Olenburger T, Biamino G, Schuler G, Scheinert D. Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 2004;44:1966–9.

    Article  PubMed  Google Scholar 

  29. Markus HS. Monitoring embolism in real time. Circulation 2000;102:826–8.

    Article  PubMed  CAS  Google Scholar 

  30. Rabe K, Sugita J, Gödel H, Sievert H. Flow-reversal device for cerebral protection during carotid artery stenting — acute and long-term results. J Interv Cardiol 2006;19:55–62.

    Article  PubMed  Google Scholar 

  31. Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke 2003;34(8):1936–41.

    Article  PubMed  Google Scholar 

  32. Parodi J, Schönholz C, Ferreira L, Mendaro E, Ohki T. “Seat belt and air bag” technique for cerebral protection during carotid stenting. J Endovasc Ther 2002;9:20–4.

    Article  PubMed  Google Scholar 

  33. Krapf H, Nagele T, Kastrup A, Buhring U, Gronewaller E, Skalej M, Kuker W. Risk factors for periprocedural complications in carotid artery stenting without filter protection. A serial diffusion-weighted imaging. AJNE Am J Neuroradiol 2005;26:376–84.

    Google Scholar 

  34. Aronow HD, Shishehbor M, Davis DA, Katzan IL, Bhatt DL, Bajzer CT, Abou-Chebl A, Derk KW, Whithlow PL, Yadav JS. Leukocyte count predicts microembolis Doppler signals during carotid stent-ing: a link between inflammation and embolization. Stroke 2005;36:1910–4.

    Article  PubMed  Google Scholar 

  35. Verhoeven BA, de Vries JP, Pasterkamp G, Ackerstaff RG, Schoneveld AH, Velema E, de Kleijn DP, Moll FL. Carotid atherosclerotic plaque characteristics are associated with mcroembolization during carotid endarterectomy and procedural outcome. Stroke 2005;36:1735–40.

    Article  PubMed  CAS  Google Scholar 

  36. Biasi GM, Froio A, Diethrich EB, Deleo G, Galimberti S, Mingazzini P, Nicolaides AN, Griffin M, Raithel D, Reid DB, Valsecchi MG. Carotid plaque echolucency increases the risk of stroke in carotid stenting. The ICAROS study. Circulation 2004;110:756–62.

    Article  PubMed  Google Scholar 

  37. Reimers B, Corvaja N, Moshiri S, et al. Cerebral protection with filter devices during carotid artery stenting. Circulation 2001;104:12–5.

    Article  PubMed  CAS  Google Scholar 

  38. Baril DT, Wholey MH. Endovascular salvage of a displaced carotid filter. Endovascular Today. Challenging Cases and Great Saves. January 2008.

    Google Scholar 

  39. Chane M, Ballard A, Vanpatten A, etal. Management of detached accunet embolic protection filter during percutaneous carotid artery intervention. Vasc Dis Manag 2006;3:218–22.

    Google Scholar 

  40. Campbell JE, Bates MC, Elmore M. Endovascular rescue of a fused monorail balloon and cerebral protection device. J Endovasc Ther 2007;14:600–4.

    Article  PubMed  Google Scholar 

  41. Reimers B, Sievert H, Schuler GC, et al. Proximal endovascular flow blockage for cerebral protection during carotid artery stenting: results from a prospective multicenter registry. J Endovasc Ther 2005;12(2):156–65.

    Article  PubMed  Google Scholar 

  42. Schlüter M, Tübler T, Mathey DG, Schofer J. Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting. J Am Coll Cardiol 2002;40:890–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interventional Cardio-Angiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy

    Alberto Cremonesi, Giancarlo Biamino, Armando Liso, Shane Gieowarsingh (Fellow) & Fausto Castriota (Co-Director)

Authors
  1. Alberto Cremonesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giancarlo Biamino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Armando Liso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shane Gieowarsingh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fausto Castriota
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Northern Vascular Unit, Newcastle Upon Tyne, UK

    Sumaira Macdonald  & Gerry Stansby  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag London Limited

About this chapter

Cite this chapter

Cremonesi, A., Biamino, G., Liso, A., Gieowarsingh, S., Castriota, F. (2009). Embolic Containment Devices and How to Avoid Disaster. In: Macdonald, S., Stansby, G. (eds) Practical Carotid Artery Stenting. Springer, London. https://doi.org/10.1007/978-1-84800-299-9_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-84800-299-9_13

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84800-298-2

  • Online ISBN: 978-1-84800-299-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation