O-011 cervical carotid stenting: the effect of distal filtration on outcomes

Abstract

Purpose We conducted a retrospective review of all the carotid stent interventions performed at our institution in order to investigate the success rate and clinical outcomes of the intervention and whether these were affected by including or omitting use of a distal filter. Material and methods Institutional IRB approval was obtained. A total 41 patients (19 M/22 F) underwent carotid stent placement at our institution between 2010 and 2013; five of the patients had bilateral stents for a total of 46 interventions. Data was collected from medical records and included patient demographics, medical history, procedural details, imaging findings and short term clinical outcomes. The association between use of a distal filter and the length of the procedure, the success rate and the immediate clinical outcome were investigated. Results The majority of the patients (76%) had two or more risk factors for carotid stenosis and 52% had one or more co-morbidity, such as cardiac disease, severe lung or renal disease. Indications included recent stroke in 6 patients (13%) and TIA in 14 patients (32%), with minor or no symptoms in 24 patients (52%). In 28 consecutive interventions (61%) a distal protections filter was used and in the next 18, the distal filter was omitted. The success rate for all the carotid stent interventions was 100%. Three patients had minor infarcts in the immediate post-operative period documented by MRI and two patients had major infarcts. One patient died secondary to a large reperfusion intracranial hemorrhage. The two major infarcts and two of the minor infarct were in cases that used the distal filter. One minor infarct was the only complication in the group without the distal filter. The length of procedure was longer in the distal filter group (mean difference of 18 min), approaching statistical significance (p = 0.06). In four of the cases, there was significant difficulty in retrieving the distal filter, causing increased procedure length and total fluoroscopy time. Discussion/conclusion The use of distal filter posed potential intra-procedural risks such as difficulty to retrieve, contributing to increased procedure time and cost whereas it had no negative impact on the immediate clinical outcome. We hope that this study will provide important quality control information of whether eliminating the use of distal filter is a cost-effective and safe alternative in carotid stent interventions. Disclosures A. Achiriloaie: None. J. Jacobson: None. U. Oyoyo: None. R. Strilaeff: None.