Surgery for Cerebral Stroke
Online ISSN : 1880-4683
Print ISSN : 0914-5508
ISSN-L : 0914-5508
Original Articles
Reconsidering the Treatment Strategy for Carotid Artery Stenting with FilterWire EZ: Focusing on the Risk Factors for Flow Impairment during the Procedure
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2023 Volume 51 Issue 3 Pages 201-207


Objectives: The risk factors for flow impairment associated with FilterWire EZ (FW-EZ) during carotid artery stenting (CAS) remain unknown. This study aimed to investigate the incidence of flow impairment during the procedure and to reconsider the therapeutic indications for FW-EZ protection in CAS.

Materials and Methods: Between January 2015 and July 2020, an FW-EZ protection device was used in sixty-eight patients with tailored CAS. We retrospectively compared patients with flow impairment (the impairment group) to those without flow impairment (the normal group) in terms of patient characteristics, soft plaque imaging, and procedural results.

Results: Flow impairment was observed in thirteen (19.1%) patients. The proportion of symptomatic lesions was significantly higher in the impairment group (76.9% vs. 27.3%, p < 0.001) as compared to the normal group. On the soft plaque imaging, maximum plaque/muscle (P/M) ratio (mean 1.9 vs 1.6; p = 0.002), maximum axial cross-sectional soft plaque area (mean 31.3 mm2 vs 25.7 mm2 ; p = 0.006), maximum long axis (mean 16.8 mm vs 9.7 mm; p < 0.001), and soft plaque volume (mean 521.2 mm3 vs 202.7 mm3 ; p < 0.001) were significantly high in the impairment group. In postoperative diffusion-weighted images, the incidence of ischemic lesions was higher in the impairment group (76.9% vs. 27.3%; p = 0.001) as compared to the normal group. In comparison to the normal group, the incidence of delayed cerebral thrombosis within 30 days was higher in the impairment group (23.1% vs. 0%, p = 0.002).

Conclusion: CAS with an FW-EZ protection device might be at a high risk of flow impairment in cases of symptomatic lesions with high-volume soft plaques. For these lesions, it is recommended to select a different protection system.

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© 2023 by The Japanese Society on Surgery for Cerebral Stroke
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