Association between plaque echogenicity and embolic material captured in filter during protected carotid angioplasty
T G Giannakopoulos1, K Moulakakis, G S Sfyroeras
1Department of Vascular Surgery, University of Athens Medical School, Attikon University Hospital, 1 Rimini Street, Athens, Greece. t.g.giannakopoulos@gmail.com
Insights
Embolic material in filter devices during carotid artery stenting is linked to echolucent plaques and hypertension. Shorter time from symptom to stenting also increases debris presence.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Carotid artery stenting (CAS) is a procedure to prevent stroke.
- Embolic protection devices (EPDs) are used to capture debris during CAS.
- Understanding debris composition and predictors is crucial for improving CAS outcomes.
Purpose of the Study:
- To investigate debris captured in filter embolic protection devices (EPDs) during carotid artery stenting (CAS).
- To explore the correlation between plaque echogenicity, hypertension, and the presence of embolic material.
- To assess the impact of time from symptom onset to CAS on debris quantity.
Main Methods:
- Prospective study of 53 CAS procedures in 51 patients.
- Ultrasonographic Gray-Weale plaque characterization (types I-V).
- Analysis of filter EPDs using liquid-based cytology (LBC) for embolic material detection.
Main Results:
- Embolic material was detected in 56.6% of filters via LBC.
- Echolucent plaques (type I) were associated with a 2.38-fold increased risk of embolic material.
- Hypertension was strongly associated with increased embolic material detection (OR=20.4).
- Shorter time from symptom to CAS correlated inversely with debris quantity (rho=-0.716, p=0.02).
Conclusions:
- Echolucent carotid plaques, hypertension, and a shorter time interval from symptom onset to CAS are associated with increased embolic material in EPDs.
- These findings highlight key factors influencing embolic load during CAS.
- Further research may optimize EPD use and patient selection.
Objectives/Design:
The aim of the study was to investigate debris captured in filter embolic protection devices (EPDs) during carotid artery stenting (CAS) and its possible correlation with plaque echogenicity and other risk factors.
Materials/Methods:
Between June 2010 and March 2011, 51 consecutive CAS patients (11 females, mean age 71.2 ± 7, 10 symptomatic) who underwent 53 procedures were included in this prospective study. Ultrasonographic Gray-Weale plaque type (I-V, echolucent to echogenic) characterisation was obtained in all cases. The same type of stent and filter EPD was used. Filters were collected and, after macroscopic evaluation, they were examined using the Thin-Prep(®) liquid-based cytology (LBC) technique.
Results:
Technical success was 100%. Thirty-day stroke and death rates were 1.8% (1/53) and 0%, respectively. Visible debris was detected in eight (15%) filters, whereas LBC revealed the presence of embolic material particles in 30 filters (56.6%). The presence of embolic material into the filter EPD was 2.38-fold increased for every category change from type IV to type I carotid plaques (OR = 2.38, 95%CI = 1.15-4.93). This association remained robust even after adjustment for age, gender and known atherosclerotic disease risk factors (OR = 2.26, 95%CI = 1.02-5.02). In multivariate analysis for risk factors, hypertension was associated with increased presence of embolic material detection in filter EPD (OR = 20.4, 95%CI = 1.28-326.1). The time distance from symptom to CAS was inversely correlated with debris quantity in EPD (Spearman rho -0.716; p = 0.02).
Conclusions:
Echolucent plaques, smaller time frame from last symptom and hypertension were associated with increased presence of embolic material.
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