Evaluation of Carotid Artery Stenting with Distal Filter Protection Device

Abstract

Abstract Objectives To assess the use of proximal protection devices in consecutive patients as the preferred means of cerebral embolic protection for primary carotid stenting. Methods and Results This was a prospective single-center study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic (≥ 50%) and asymptomatic (≥ 70%) carotid stenosis. Proximal protection devices were used for embolic protection in 115 consecutive patients. No patients were excluded for anatomical reasons. The filter used was of diameters 6 mm in all cases (Emboshield NAV filter device, Abbotts Healthcare Pvt. Ltd. [Lake Bluff, Il]). In all cases, self-expanding closed-cell designed stent was used (X-act closed-cell self-expanding nitinol carotid-tapered stent, Abbotts Healthcare Pvt. Ltd.). Plaque characterization was done by using real-time high-resolution ultrasound (HR USG) equipment (Aloka Prosound Alpha 7 [Chiyoda, Tokyo, Japan]) using high-frequency linear transducers (> 7 MHz). Follow-up duration was 30 days. Mean age was 61.9 ± 8.27 years. There was male predominance observed in study accounting for 73 out of total 115 studied population. Fifty-six of 115 (48.89%) treated stenoses were symptomatic. Technical success was achieved in 115 of 115 (100%) cases. In both the cases, additional distal filter devices were used. Carotid stenting was successful in 115 (100%) lesions. This study observed higher number of debris in symptomatic and high-risk plaques. This study also observed higher sensitivity, specificity, and accuracy of updated classification for assessing risk of microembolism (captured debris) (sensitivity 73.91%, specificity 95.65%, positive predictive value [PPV] 91.89%, negative predictive value [NPV] 84.62%, accuracy 86.95%). In our study, minor stroke was seen in three (2.61%) patients within 48 hours, and no adverse events were seen within 48 hours to 1 month. Conclusion Proximal protection is a safe method as the first choice for embolic protection. It can be used with a high rate of technical success.