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In vitro evaluation of the embolic risk of diagnostic and therapeutic intravascular procedures
1Department of Radiology, Semmelweis University Faculty of Health Sciences, Budapest, Hungary.
Background:
The purpose of the study was to evaluate the risk of distal embolisation in a silicon model during different endovascular diagnostic and therapeutic procedures.
Material And Methods:
Endovascular technics, such as guidewire and catheter advancement, metal stent placement and balloon angioplasty were compared. Clots were produced from human blood sample. The transparent silicon model was filled with saline, flow was generated by an hydraulic pump. Stenosis was created by mechanical compression. The size of the circulating particles were measured with a mesh of nylon filters.
Results:
No loose particles were detected using guidewire, pigtail and straight catheters. Balloon inflation induced embolisation of particles ranging from 100 microns to 10 mm in length. Deployment of self expandable metallic stents did not result in particle migration but secondary angioplasty inside the stent detached particles (ranging from 400 microns to 12 mm in length). Deployment of balloon expandable stent yielded in the stretching of the clot, which became sometimes longer than the stent, resulting in the detachment of the non covered portion.
Conclusion:
The risk of distal embolisation during guide-wires and catheters manipulation is not significant. Balloon catheters and secondary angioplasty after deployment of self-expanding stents caused large particles detachment.