Risk Factors and Complications Associated with Difficult Retrieval of Embolic Protection Devices in Carotid Artery Stenting

Abstract

This study was designed to investigate the risk factors and complications of difficult retrieval (DR) of embolic protection devices (EPDs) in carotid artery stenting (CAS). A total of 195 consecutive patients who underwent CAS between December 2007 and March 2010 in a general hospital were enrolled and divided into two groups: with DR and without DR. The risk factors of DR were analyzed with univariate and multivariate analyses. The complications of DR were recorded and analyzed. A total of 30 (15.4%) patients with DR of EPDs were observed, of whom EPDs were successfully retrieved in 29, and in 1 was it taken out by surgical treatment. The retrieval time was significantly longer in patients with DR (490.5±143.9s) than in patients without DR (157.2±15.7s, p=0.000). Vasospasm was observed more frequently in patients with DR than in patients without DR (55.2% vs. 14.5%, p=0.000). Intracranial compilations were more frequent in patients with DR than in those without DR (17.2% vs. 0.6%, p=0.000). Calcified plaques, degree of residual stenosis, types of the stents, and tortuosity index (TI>80°) were all associated with DR. A logistic regression analysis indicated that calcified plaques (odds ratio (OR)=6.5; p=0.000) and TI>80° (OR=18.8; p=0.000) were independent predictors of DR. Calcified plaques and TI>80° may be related to DR in patients with CAS. DR may lengthen the retrieving time and increase the complications of the procedure.