Abstract
We report the usefulness of a routine aspiration method, in which aspirations of blood column in the proximal internal carotid artery (ICA) to the filter are always performed regardless of the flow state on digital subtraction angiography immediately before the filter retrieval to prevent ischemic complications in filter protected carotid artery stenting (CAS). The purposes of the present study were to summarize the clinical results of patients undergoing CAS using the routine aspiration method and Angioguard XP, and to investigate limitations of this method and countermeasures to prevent ischemic complications.
The routine aspiration method was performed in 71 consecutive CAS procedures using Angioguard XP between November 2008 and June 2010. Two patients suffered from stroke within 30 days of the procedures (2.8%). Cerebral infarction occurred during CAS in 1 patient, and cerebral hemorrhage by hyperperfusion syndrome occurred 2 days after CAS in another. In the cerebral infarction case, the ICA was kinking just distal to the stenosis, and the kink was extended by the CAS procedure. A large amount of debris was found in both the retrieved filter and the aspirated blood columns.
Even in the routine aspiration method, ischemic complications can occur in a few cases. In cases of a kink in the ICA just distal to the stenosis, avoidance of the kink extension during CAS is recommended to prevent ischemic complications.
