Prediction of postprocedural filter debris after transcarotid revascularization
Katherin Leckie1, Akiko Tanaka2, Mackenzie K Madison1
1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Vascular
|May 31, 2022
Summary
Filter debris in Transcarotid Revascularization (TCAR) is linked to longer flow reversal times and higher comorbidity scores. However, contralateral carotid occlusion appears protective against debris formation during carotid stenting.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Transcarotid revascularization (TCAR) uses cerebral flow reversal for embolic protection during carotid stenting.
- Filter debris from TCAR may indicate high-risk carotid lesions prone to embolization.
Purpose of the Study:
- To investigate if filter debris during TCAR can characterize carotid lesions at high risk for embolization.
- To identify predictors of intraoperative filter debris in TCAR procedures.
Main Methods:
- Retrospective review of TCAR procedures across two health systems.
- Analysis of demographics, preoperative variables, and intraoperative data.
- Multivariate logistic regression to identify predictors of filter debris.
Main Results:
- Filter debris was observed in 323 of 693 TCAR cases.
- Higher incidence of neck radiation and Charlson Comorbidity Index (CCI) in the debris cohort.
- Longer intraoperative flow reversal and fluoroscopy times were associated with filter debris.
- Contralateral carotid occlusion was less common in the debris cohort and found to be protective.
Conclusions:
- Visible filter debris after TCAR is independently associated with extended reverse flow time and elevated CCI.
- Contralateral carotid occlusion is a protective factor against filter debris formation during TCAR.
