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Published in: Neurosurgical Review 4/2015

01-10-2015 | Original Article

Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience

Authors: Yosuke Kajihara, Shigeyuki Sakamoto, Yoshihiro Kiura, Kazutoshi Mukada, Takahiro Chaki, Shiro Kajihara, Kaoru Kurisu

Published in: Neurosurgical Review | Issue 4/2015

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Abstract

There are several protection methods used to prevent distal embolism during carotid artery stenting (CAS). The aim of this study was to compare the dual protection method (proximal balloon and distal filter protection) with the distal filter protection during CAS performed at a single center. Between April 2008 and November 2013, 78 consecutive patients with internal carotid artery stenosis were treated with CAS at Istukaichi Memorial Hospital. Twenty-four consecutive patients were treated with CAS using distal filter protection (distal filter protection group), and 54 consecutive patients were treated with CAS using dual protection with a proximal balloon and distal filter protection (dual protection group). We examined the hyperintensity lesions on diffusion-weighted imaging (DWI) and perioperative complications after CAS. All stenotic lesions were successfully dilated. DWI showed hyperintensity lesions among 54.2 % (13/24 patients) in the distal filter protection group and in 27.8 % (15/54 patients) in the dual protection group (p = 0.024). The average number of hyperintensity lesions on DWI was 1.75 (range, 0 to 6) in the distal filter protection group and 0.59 (range, 0 to 5) in the dual protection group (p = 0.0087). Postprocedural persistent ischemic complications occurred in 4.2 % (1/24 patients) in the distal filter protection group and 3.7 % (2/54 patients) in the dual protection group (p = 0.67). In this study, the dual protection method reduced the number of hyperintensity lesions seen on DWI when compared with the distal filter protection method when used for distal embolic protection during CAS.
Literature
1.
go back to reference Asakura F, Kawaguchi K, Sakaida H, Toma N, Matsushima S, Kuraishi K, Tanemura H, Miura Y, Maeda M, Taki W (2006) Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow. AJNR Am J Neuroradiol 27:753–758PubMed Asakura F, Kawaguchi K, Sakaida H, Toma N, Matsushima S, Kuraishi K, Tanemura H, Miura Y, Maeda M, Taki W (2006) Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow. AJNR Am J Neuroradiol 27:753–758PubMed
2.
go back to reference Bates ER, Babb JD, Casey DE Jr, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ (2007) ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on carotid stenting. Vasc Med 12:35–83CrossRefPubMed Bates ER, Babb JD, Casey DE Jr, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ (2007) ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on carotid stenting. Vasc Med 12:35–83CrossRefPubMed
3.
go back to reference Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L (1999) Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354:1594–1597CrossRefPubMed Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L (1999) Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354:1594–1597CrossRefPubMed
4.
go back to reference Bijuklic K, Wandler A, Hazizi F, Schofer J (2012) The PROFI study (prevention of cerebral embolization by proximal balloon occlusion compared to filter protection during carotid artery stenting): a prospective randomized trial. J Am Coll Cardiol 59:1383–1389CrossRefPubMed Bijuklic K, Wandler A, Hazizi F, Schofer J (2012) The PROFI study (prevention of cerebral embolization by proximal balloon occlusion compared to filter protection during carotid artery stenting): a prospective randomized trial. J Am Coll Cardiol 59:1383–1389CrossRefPubMed
5.
go back to reference Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, CREST Investigators (2010) Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med 362:11–23CrossRef Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, CREST Investigators (2010) Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med 362:11–23CrossRef
6.
go back to reference Coggia M, Goëau-Brisonniere O, Duval JL, Leschi JP, Letort M, Nagel MD (2000) Embolic risk of the different stages of carotid bifurcation balloon angioplasty: an experimental study. J Vasc Surg 31:550–557CrossRefPubMed Coggia M, Goëau-Brisonniere O, Duval JL, Leschi JP, Letort M, Nagel MD (2000) Embolic risk of the different stages of carotid bifurcation balloon angioplasty: an experimental study. J Vasc Surg 31:550–557CrossRefPubMed
7.
go back to reference Endo S, Kuwayama N, Hirashima Y (2004) Japan carotid atherosclerosis study. Neurol Med Chir (Tokyo) 44:215–217CrossRef Endo S, Kuwayama N, Hirashima Y (2004) Japan carotid atherosclerosis study. Neurol Med Chir (Tokyo) 44:215–217CrossRef
8.
go back to reference Eskandari MK, Najjar SF, Matsumura JS, Kibbe MR, Morasch MD (2007) Technical limitations of carotid filter embolic protection devices. Ann Vasc Surg 21:403–407CrossRefPubMed Eskandari MK, Najjar SF, Matsumura JS, Kibbe MR, Morasch MD (2007) Technical limitations of carotid filter embolic protection devices. Ann Vasc Surg 21:403–407CrossRefPubMed
9.
go back to reference Finol EA, Siewiork GM, Scotti CM, Wholey MH, Wholey MH (2008) Wall apposition assessment and performance comparison of distal protection filters. J Endovasc Ther 15:177–185CrossRefPubMed Finol EA, Siewiork GM, Scotti CM, Wholey MH, Wholey MH (2008) Wall apposition assessment and performance comparison of distal protection filters. J Endovasc Ther 15:177–185CrossRefPubMed
10.
go back to reference Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Ansel G, Strickman NE, Wang H, Cohen SA, Massaro JM, Cutlip DE, SAPPHIRE Investigators (2008) Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358:1572–1579CrossRefPubMed Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Ansel G, Strickman NE, Wang H, Cohen SA, Massaro JM, Cutlip DE, SAPPHIRE Investigators (2008) Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358:1572–1579CrossRefPubMed
11.
go back to reference Harada K, Morioka J, Higa T, Saito T, Fukuyama K (2012) Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and avaluation of debris capture. Ann Vasc Surg 26:929–936CrossRefPubMed Harada K, Morioka J, Higa T, Saito T, Fukuyama K (2012) Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and avaluation of debris capture. Ann Vasc Surg 26:929–936CrossRefPubMed
12.
go back to reference Harada K, Kakumoto K, Morioka J, Saito T, Fukuyama K (2014) Combination of flow reversal and distal filter for cerebral protection during carotid artery stenting. Ann Vasc Surg 28:651–658CrossRefPubMed Harada K, Kakumoto K, Morioka J, Saito T, Fukuyama K (2014) Combination of flow reversal and distal filter for cerebral protection during carotid artery stenting. Ann Vasc Surg 28:651–658CrossRefPubMed
13.
go back to reference Henry M, Polydorou A, Henry I, Polydorou A, Hugel M (2004) Carotid angioplasty under cerebral protection with the PercuSurge GuardWire System. Catheter Cardiovasc Interv 61:293–305CrossRefPubMed Henry M, Polydorou A, Henry I, Polydorou A, Hugel M (2004) Carotid angioplasty under cerebral protection with the PercuSurge GuardWire System. Catheter Cardiovasc Interv 61:293–305CrossRefPubMed
14.
go back to reference Jaeger HJ, Mathias KD, Hauth E, Drescher R, Gissler HM, Hennigs S, Christmann A (2002) Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery. AJNR Am J Neuroradiol 23:200–207PubMed Jaeger HJ, Mathias KD, Hauth E, Drescher R, Gissler HM, Hennigs S, Christmann A (2002) Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery. AJNR Am J Neuroradiol 23:200–207PubMed
15.
go back to reference Kuwayama N, Endo S, JCAS Group (2010) Japan Carotid Atherosclerosis Study. J Jpn Coll Angiol 50:723–727, (Jpn) Kuwayama N, Endo S, JCAS Group (2010) Japan Carotid Atherosclerosis Study. J Jpn Coll Angiol 50:723–727, (Jpn)
16.
go back to reference Miyachi S, Taki W, Sakai N, Nakahara I, The Japanese CAS Survey Investigators (2012) Historical perspective of carotid artery stenting in Japan: analysis of 8,092 cases in The Japanese CAS survey. Acta Neurochir (Wien) 154:2127–2137CrossRef Miyachi S, Taki W, Sakai N, Nakahara I, The Japanese CAS Survey Investigators (2012) Historical perspective of carotid artery stenting in Japan: analysis of 8,092 cases in The Japanese CAS survey. Acta Neurochir (Wien) 154:2127–2137CrossRef
17.
go back to reference Parodi JC, Ferreira LM, Sicard G, La Mura R, Fernadez S (2005) Cerebral protection during carotid stenting using flow reversal. J Vasc Surg 41:416–422CrossRefPubMed Parodi JC, Ferreira LM, Sicard G, La Mura R, Fernadez S (2005) Cerebral protection during carotid stenting using flow reversal. J Vasc Surg 41:416–422CrossRefPubMed
18.
go back to reference Rapp JH, Pan XM, Yu B, Swanson RA, Higashida RT, Simpson P, Saloner D (2003) Cerebral ischemia and infarction from atheroemboli <100 micron in size. Stroke 10:1976–1980CrossRef Rapp JH, Pan XM, Yu B, Swanson RA, Higashida RT, Simpson P, Saloner D (2003) Cerebral ischemia and infarction from atheroemboli <100 micron in size. Stroke 10:1976–1980CrossRef
19.
go back to reference Sakamoto S, Kiura Y, Kajihara Y, Shibukawa M, Okazaki T, Matsushige T, Shinagawa K, Mukada K, Kurisu K (2013) Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery. Neurosurg Rev 36:551–558CrossRefPubMed Sakamoto S, Kiura Y, Kajihara Y, Shibukawa M, Okazaki T, Matsushige T, Shinagawa K, Mukada K, Kurisu K (2013) Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery. Neurosurg Rev 36:551–558CrossRefPubMed
20.
go back to reference Schmidt A, Diederich KW, Scheinert S, Bräunlich S, Olenburger T, Biamino G, Schuler G, Scheinert D (2004) Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 44:1966–1969CrossRefPubMed Schmidt A, Diederich KW, Scheinert S, Bräunlich S, Olenburger T, Biamino G, Schuler G, Scheinert D (2004) Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 44:1966–1969CrossRefPubMed
21.
go back to reference Schnaudigel S, Groschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919CrossRefPubMed Schnaudigel S, Groschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919CrossRefPubMed
22.
go back to reference Siewiorek GM, Wholey MH, Finol EA (2007) In vitro performance assessment of distal protection devices for carotid artery stenting: effect of physiological anatomy on vascular resistance. J Endovasc Ther 14:712–724CrossRefPubMed Siewiorek GM, Wholey MH, Finol EA (2007) In vitro performance assessment of distal protection devices for carotid artery stenting: effect of physiological anatomy on vascular resistance. J Endovasc Ther 14:712–724CrossRefPubMed
23.
go back to reference Stabile E, Salemme L, Sorropago G, Tesorio T, Nammas W, Miranda M, Popusoi G, Cioppa A, Ambrosini V, Cota L, Petroni G, Della Pietra G, Ausania A, Fontanelli A, Biamino G, Rubino P (2010) Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol 55:1661–1667CrossRefPubMed Stabile E, Salemme L, Sorropago G, Tesorio T, Nammas W, Miranda M, Popusoi G, Cioppa A, Ambrosini V, Cota L, Petroni G, Della Pietra G, Ausania A, Fontanelli A, Biamino G, Rubino P (2010) Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol 55:1661–1667CrossRefPubMed
24.
go back to reference Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, Itakura T (2006) Endovascular treatment for pseudo-occlusion of the internal carotid artery. Neurosurgery 59:301–309CrossRefPubMed Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, Itakura T (2006) Endovascular treatment for pseudo-occlusion of the internal carotid artery. Neurosurgery 59:301–309CrossRefPubMed
25.
go back to reference Timaran CH, Rosero EB, Martinez AE, IIarraza A, Modrall JG, Clagett GP (2010) Atheroscleroitic plaque composition assed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 52:1194–1195CrossRef Timaran CH, Rosero EB, Martinez AE, IIarraza A, Modrall JG, Clagett GP (2010) Atheroscleroitic plaque composition assed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 52:1194–1195CrossRef
26.
go back to reference Wasser K, Pilgram-Pastor SM, Schaudigel S, Stojanovic T, Schmidt H, Knauf J, Gröschel K, Knauth M, Hildebrandt H, Kastrup A (2011) New brain lesions after carotid revascularization are not associated with cognitive performance. J Vasc Surg 53:61–70CrossRefPubMed Wasser K, Pilgram-Pastor SM, Schaudigel S, Stojanovic T, Schmidt H, Knauf J, Gröschel K, Knauth M, Hildebrandt H, Kastrup A (2011) New brain lesions after carotid revascularization are not associated with cognitive performance. J Vasc Surg 53:61–70CrossRefPubMed
27.
go back to reference Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501CrossRefPubMed Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501CrossRefPubMed
Metadata
Title
Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience
Authors
Yosuke Kajihara
Shigeyuki Sakamoto
Yoshihiro Kiura
Kazutoshi Mukada
Takahiro Chaki
Shiro Kajihara
Kaoru Kurisu
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 4/2015
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-015-0639-x

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