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Clinical implications of internal carotid artery flow impairment caused by filter occlusion during carotid artery

O-K Kwon1, S H Kim, E A Jacobsen

  • 1Clinical Neuroscience Center, Seoul National University Bundang Hospital, Bundang, South Korea.

AJNR. American Journal of Neuroradiology
|December 17, 2011
PubMed

Insights

Filter occlusion during carotid artery stenting (CAS) is common, especially in severe stenosis. While it can temporarily halt internal carotid artery (ICA) flow, it resolves quickly upon filter removal and does not worsen patient outcomes.

Area of Science:

  • Interventional Neuroradiology
  • Vascular Surgery
  • Cardiovascular Research

Background:

  • Cerebral embolic protection devices (EPDs) are used during carotid artery stenting (CAS) to preserve internal carotid artery (ICA) flow.
  • Filter occlusion, leading to ICA flow arrest, is a potential complication of EPD use during CAS.

Purpose of the Study:

  • To describe the angiographic, clinical, and histopathologic features of filter occlusion during CAS.
  • To evaluate the incidence and impact of filter occlusion on patient outcomes.

Main Methods:

  • Sixty-one patients with cervical carotid stenosis undergoing CAS with a specific filter device were evaluated.
  • Dual antiplatelet therapy and full heparinization were administered; pre- and post-stent dilations were performed.
  • Filters were inspected for debris, and histology was obtained if occlusion occurred.

Main Results:

  • Filter occlusion occurred in 9.8% of patients, predominantly in those with severe stenosis.
  • Occlusion typically happened after stent deployment or prestent dilation and resolved immediately upon filter removal.
  • Histopathology revealed fibrin as the primary occlusive material; no significant difference in diffusion MRI was noted between occluded and non-occluded groups.

Conclusions:

  • ICA flow arrest due to filter occlusion during CAS is a relatively frequent event, particularly in severe carotid stenosis.
  • Filter occlusion is transient, resolves rapidly with filter removal, and does not appear to negatively impact neurological outcomes.
Abstract

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