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Published on: May 14, 2013
Effects of Aspiration and Re-transfusion Technique with Carotid Artery Stenting
Yoshiaki Tokuyama1, Tatsuro Takada1, Noriko Usuki1
1Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan.
Insights
The aspiration and re-transfusion technique (ART) with carotid artery stenting (CAS) reduced embolic complications. ART shows promise in lowering stroke incidence and reducing lesion size after CAS.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Interventional Radiology
Background:
- Embolic stroke is a significant risk following carotid artery stenting (CAS).
- Embolic protection devices (EPDs) help reduce stroke incidence, but optimal device selection remains debated.
- The aspiration and re-transfusion technique (ART) combined with distal balloon protection was implemented to mitigate embolic events during CAS.
Purpose of the Study:
- To evaluate the effectiveness of the aspiration and re-transfusion technique (ART) in reducing embolic complications during carotid artery stenting (CAS).
- To compare the incidence of diffusion-weighted imaging (DWI)-positive lesions and symptomatic ischemic stroke between patients treated with ART and those without.
Main Methods:
- A retrospective study included 243 patients undergoing CAS with distal balloon protection.
- 202 patients underwent ART (ART group), while 40 did not (non-ART group).
- ART involved aspirating blood, filtering it, and re-transfusing it, with debris assessment.
Main Results:
- The ART group showed a trend towards reduced DWI-positive lesions (22.7% vs 37.5%) and symptomatic ischemic stroke (0.9% vs 5.0%) compared to the non-ART group.
- ART significantly reduced hemoglobin reduction rate (11.1% vs 14.9%, P <0.01).
- Fewer multiple and large lesions were observed in the ART group.
Conclusions:
- Carotid artery stenting (CAS) with distal balloon protection and the aspiration and re-transfusion technique (ART) is effective in reducing DWI-positive lesions.
- ART may be beneficial in decreasing the incidence of symptomatic ischemic stroke after CAS.
Objective:
Embolic stroke is the most serious complication after carotid artery stenting (CAS). The incidence rate of embolic stroke is reduced by the use of embolic protection devices (EPDs); however, there is no consensus on which EPD is the most effective. The aspiration and re-transfusion technique (ART) with CAS under distal balloon protection was adopted at our center to reduce the incidence of embolic complications. This retrospective study investigated the effects of ART.
Methods:
From November 2010, 243 consecutive patients treated by CAS under distal balloon protection were included. ART was performed on 202 patients (ART group) and the other 40 patients only received distal balloon protection (non-ART group). In ART, the blood from the aspiration catheter was continuously returned through a filter to the femoral vein. The amount of debris was assessed intermittently using a small blood sample and the rest was returned. We investigated the diffusion-weighted imaging (DWI)-positive rate and symptomatic ischemic stroke one day after CAS.
Results:
Compared with the non-ART group, the incidence of DWI-positive lesions (22.7% vs 37.5%, P = 0.07) and frequency of symptomatic ischemic stroke (0.9% vs 5.0%, P = 0.12) were reduced in the ART group. The hemoglobin reduction rate was significantly reduced by ART (11.1% vs 14.9%, P <0.01). In the ART group, the frequency of multiple lesions (more than 5) and large lesions (more than 10 mm) was lower than that in the non-ART group (P <0.01, P = 0.14).
Conclusion:
CAS under distal balloon protection with ART was effective at reducing the incidence of DWI-positive lesions and may be useful to reduce the incidence of symptomatic ischemic stroke.
