Pyoktanin Blue Method for Staining Fractured Plaques

Abstract

Objective: To improve the safety of carotid artery stenting (CAS), reducing the risk of perioperative ischemic complications is mandatory. To achieve this, embolic protection devices (EPD) are being used in the majority of the procedure. With the GuardWire Temporary Occlusion and Aspiration System EPD, complete evacuation of the plaque debris before deflating the occlusion balloon is important to avoid cerebral thromboembolism. We report a novel method to stain the debris on the filter device to enhance the visualization of the retrieved debris so as to facilitate complete removal of the thromboembolic source.Case Presentations: The filter devices were immersed with 0.5 ml of 1% pyoktanin solution for 5 s and irrigated with saline during the CAS procedure. The pre-stained and stained filters were compared for the visibility of the debris. The pyoktanin staining enhanced the visualization of minute debris captured on the filter that was not well recognized before the staining.Conclusion: This simple technique was effective in improving the visualization of the evacuated plaque debris and may decrease distal embolism caused by previously unrecognized debris.