Efficacy of Carotid Artery Stenting by the Universal Protection Method

Shunsaku Goto; Tomotaka Ohshima; Kyozo Kato; Takashi Izumi; Toshihiko Wakabayashi

doi:10.1016/j.jstrokecerebrovasdis.2018.03.018

Efficacy of Carotid Artery Stenting by the Universal Protection Method

J Stroke Cerebrovasc Dis. 2018 Aug;27(8):2187-2191. doi: 10.1016/j.jstrokecerebrovasdis.2018.03.018. Epub 2018 Apr 18.

Authors

Shunsaku Goto¹, Tomotaka Ohshima², Kyozo Kato³, Takashi Izumi⁴, Toshihiko Wakabayashi⁴

Affiliations

¹ Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan; Department of Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan. Electronic address: [email protected].
³ Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
⁴ Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

PMID: 29680303
DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.018

Abstract

Purpose: To avoid distal plaques embolization during carotid artery stenting, we developed Universal Protection Method that combined the use of a proximal common carotid artery balloon, an external carotid artery balloon, and a distal internal carotid artery filter, with continuous flow reversal to the femoral vein. Herein, we assessed the efficacy of the Universal Protection Method by comparing stenting outcomes before and after its introduction.

Materials and methods: We assessed outcomes for 115 cases before and 41 cases after the Universal Protection Method was adopted (non-Universal Protection Method and Universal Protection Method groups, respectively). We then compared procedure details, magnetic resonance imaging (within 48 hours after the procedure), intraprocedural complications, and postoperative stroke rates.

Results: Ischemic stroke was not observed in the Universal Protection Method group, but 1 major stroke and 2 minor strokes were observed in the non-Universal Protection Method group. High-intensity areas were seen in 6 (15.0%) and 49 (42.6%) cases in the Universal Protection Method and non-Universal Protection Method groups, respectively (P = .001). Contrastingly, intraprocedural complications were observed in 9 (22.5%) and 21 (18.3%) cases in the Universal Protection Method and non-Universal Protection Method groups, respectively. Among these intraprocedural complication cases, high-intensity areas were observed in 1 case (11.1%) in the Universal Protection Method group and in 15 cases (71.4%) in the non-Universal Protection Method group.

Conclusions: Universal Protection Method is a safe technique that is applicable to all patients undergoing carotid artery stenting, irrespective of individual risk factors. Notably, the incidence rates of both distal embolization and unexpected intraprocedural complications are low.

Keywords: Carotid artery stenting; distal embolization; embolization protection device; reversal flow.

MeSH terms

Aged
Brain Ischemia / epidemiology
Brain Ischemia / etiology
Brain Ischemia / prevention & control
Carotid Arteries / surgery*
Carotid Stenosis / complications
Carotid Stenosis / epidemiology
Carotid Stenosis / surgery*
Embolization, Therapeutic / methods*
Female
Humans
Incidence
Magnetic Resonance Imaging
Male
Platelet Aggregation Inhibitors / therapeutic use
Postoperative Complications
Retrospective Studies
Stents*
Stroke / epidemiology
Stroke / etiology
Stroke / prevention & control
Treatment Outcome

Substances

Platelet Aggregation Inhibitors