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[Reversed carotid filter for the prevention of distal emboli during an iliac recanalization]
1Service d'Imagerie Médicale, Hôtel-Dieu de France, rue Alfred Naccache, Beyrouth, Liban. sslaba@hotmail.com
Insights
A novel carotid filter effectively captured emboli during recanalization of a blocked iliac stent. This technique prevents distal embolization in complex vascular interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Iliac artery stent occlusion is a challenging clinical problem.
- Recanalization of occluded stents can lead to dangerous distal embolization.
- Existing embolic protection devices may be difficult to deploy in such scenarios.
Observation:
- A reversed carotid filter was successfully used to prevent distal emboli.
- The filter was placed distal to the occluded stent before recanalization.
- Significant embolic material was retrieved within the filter post-procedure.
Findings:
- Recanalizing an occluded iliac stent generated more emboli than native iliac artery interventions.
- The described technique allows filter placement without traversing the occluded lesion.
- This method is particularly useful when fibrinolysis is inefficient for chronic occlusions.
Implications:
- This approach offers a safe and effective method for embolic protection during complex iliac stent recanalization.
- It may reduce the risk of limb ischemia and other embolic complications.
- The technique is adaptable for similar challenging endovascular procedures requiring embolic containment.
Abstract:
We describe the use of a carotid filter in preventing distal emboli during the recanalization of an occluded left iliac stent two months earlier. The filter was reversed and introduced through an ipsilateral 6 French sheath along its 0.014" guidewire and placed against the occluded stent. The stent is recanalized using a hydrophilic guidewire controlaterally and a new stent was inserted into the old one. The filter was retracted into the introducer by pulling cut the special 0.014 guidewire, with a 0.018" diameter tip, and the whole system was removed via the left common femoral artery. Many emboli were found in the removed filter. We noted that the recanalization of an occluded stent causes more distal embolization than the native iliac artery. This technique allows placing the filter between the embolic lesion and the distal arterial territory, without passing through the lesion, especially since fibrinolysis may not be efficient in 2-months-old occlusions.
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