Routine Stent Flushing with Heparinized Saline during Distal Filter-Protected Carotid Artery Stenting: A Technical Modification to Reduce Delayed Embolization

Abstract

Delayed embolization after filter-protected carotid artery stenting (CAS) may occur because of the protrusion and release of loose atherosclerotic plaque fragments through the stent cells. We describe a technical modification to the standard filter-protected CAS by introducing an extra step, that of washing away the luminal stent surface debris with heparinized saline while the filter is still in place. Aided by the guiding catheter, flushing heparinized saline under manual pressure against the stent will force all loose fragments distally in the internal carotid artery to be captured by the overlying filter. Stent washout with heparinized saline before filter retrieval during filter-protected CAS may potentially increase debris capture and reduce delayed embolization.