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Iatrogenic vasospasm in carotid artery stent angioplasty with distal protection devices

Clemens M Schirmer1, Daniel A Hoit, Adel M Malek

  • 1Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.

Neurosurgical Focus
|February 16, 2008
PubMed

Insights

First-generation FilterWire EX distal protection devices (DPDs) significantly increased vasospasm during carotid artery stenting. Second-generation mobile-basket DPDs and no protection showed lower vasospasm rates, suggesting improved safety.

Area of Science:

  • Interventional Cardiology
  • Vascular Surgery
  • Medical Device Technology

Background:

  • Distal protection devices (DPDs) reduce embolic stroke risk in carotid artery (CA) stenting.
  • First-generation FilterWire EX has a fixed-basket design.
  • Second-generation mobile-basket DPDs offer greater flexibility.

Purpose of the Study:

  • Compare vasospasm incidence with fixed-basket DPDs, mobile-basket DPDs, and no protection during CA stenting.
  • Evaluate the safety and efficacy of different DPDs in preventing procedural complications.

Main Methods:

  • Retrospective analysis of 40 CA stent placements (37 patients).
  • Procedures utilized fixed-basket FilterWire EX DPD (n=12), second-generation mobile-basket DPD (n=6), or no protection (n=22).
  • Recorded and analyzed clinical presentation, angiographic findings (vasospasm, dissection), and outcomes.

Main Results:

  • High vasospasm rates with fixed-basket FilterWire EX (67%) compared to mobile-basket DPDs (17%) and no protection (14%).
  • FilterWire EX use was an independent risk factor for vasospasm (p < 0.0003).
  • Secondary angioplasty also correlated with intraprocedural vasospasm.

Conclusions:

  • Fixed-basket FilterWire EX DPD is associated with a significantly higher incidence of vasospasm during CA stenting.
  • Second-generation mobile-basket DPDs did not increase vasospasm risk compared to unprotected procedures.
  • Recommend using second-generation mobile-basket DPDs to minimize embolic and iatrogenic vascular injury risks.
Abstract

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