Filter content after carotid angioplasty and stenting: Relation to ischemic lesions in diffusion-weighted imaging

Abstract

ObjectivesTo evaluate the relation between the material retrieved from distal filters after carotid angioplasty and stenting (CAS) and the development of ischemic brain lesions in diffusion-weighted imaging (DWI).To determine the influence of demographic, clinical, and procedural variables in the pathogenesis of emboli and in ischemia after CAS. Material and methodsWe submitted the contents of the filters of 76 patients (60 men; mean age, 68.39 years; range, 46–82) who had undergone angioplasty and stenting for severe stenosis of the internal carotid artery (ICA) for histologic analysis evaluating volume (<1λ=0.001ml=1μl; 1–10λ; and >10λ) and the composition of the particles. All patients underwent DWI before and 24h after the procedure; we recorded whether lesions appeared, their number, size, and distribution. We correlated the findings with demographic, clinical, and procedural variables. ResultsSymptoms were present before the procedure in 58 (76.3%) patients. Particles were present in 49 (64.5%) of the filters; most particles (77.5%) were 1λ with a predominance of fibrin-platelet aggregates, cell remnants, and cholesterol crystals. DWI after the procedure detected lesions in 12 (15.8%) patients. We found no statistically significant correlation between filter contents and lesion detection after the procedure or between filter contents and other variables. ConclusionsIschemia after CAS does not depend solely on the embolic load and its nature. We consider that the lower prevalence of postprocedural lesions in our series compared to others suggests that appropriate patient selection and experience minimize the negative influence of some variables like age in their development.