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[Carotid stenting with embolism prevention]
1Institut für Neuroradiologie, Johann Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7 60590 Frankfurt.
Insights
Théron's technique using balloon protection during carotid stenting effectively prevents embolic complications. This method, involving aspiration and flushing, demonstrated significant safety in patients with high-grade carotid stenoses.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Context:
- Endovascular treatment of extracranial carotid stenoses carries a risk of embolic complications.
- Optimizing safety is crucial for improving patient outcomes in carotid stenting procedures.
Purpose:
- To evaluate the safety and efficacy of Théron's technique for carotid stenting under balloon protection in patients with high-grade extracranial carotid stenoses.
- To assess the effectiveness of aspiration and flushing in removing embolic material during the procedure.
Summary:
- Théron's technique, involving temporary balloon occlusion of the internal carotid artery, aspiration, and flushing, was applied to 31 patients.
- Technical feasibility was improved with steerable guide wires and integrated balloons.
- No periprocedural strokes were observed, and microscopic analysis of aspirated blood confirmed the presence and removal of embolic particles (cholesterol crystals, fat particles up to 600 mu).
Impact:
- The technique demonstrates effectiveness in eliminating embolic particles, suggesting that stent meshwork and pharmacological treatments alone may not be sufficient.
- The proven presence of micro-emboli and low clinical complication rates support the continued use and development of this protection technique.
- This approach offers a promising strategy for enhancing the safety of carotid stenting and reducing stroke risk.
Abstract:
To optimize the safety of endovascular treatment and to prevent embolic complications, Théron's technique of carotid stenting under balloon protection was applied successfully to 31 patients with high grade extracranial carotid stenoses. Dilatation of the stenosis and stent deployment are performed under temporary balloon occlusion of the distal internal carotid artery. Blood flow is restored after aspiration as well as flushing of potential emboli from the external carotid territory. Initially a hand-mounted non-steerable protection balloon catheter caused technical difficulties in the passage of some stenoses with irregular plaque surfaces. Steerable guide wires with integrated balloons improved the technical feasibility of the protection technique. Up to now no periprocedural strokes were observed. Microscopic examination of the aspirated blood showed numerous cholesterol crystals and fat particles with sizes up to 600 mu which in model experiments with the use of pulsatile perfused silicone carotids showed the effectiveness of aspiration and flushing in the elimination of embolic particles. We assume that the meshwork of the stent, antiplatelets and periprocedural anticoagulation provide no sufficient protection against materials released from the necrotic core of the atherosclerotic plaque. The proven presence of micro-emboli as well as low clinical rates are arguments for further use and development of the protection technique.