Analysis of emboli during carotid stenting with distal protection device

Chin I. Chen, Yasuyuki Iguchi, Zsolt Garami, Marc Malkoff, Richard W. Smalling, Morgan S. Campbell, Andrei Alexandrov

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: The newly developed multi-frequency transcranial Doppler (TCD) is able to differentiate gaseous from solid emboli. Our goal was to apply this technology to initially characterize emboli detected during carotid stenting with distal protection. Methods: Patients undergoing carotid angiography and stenting were monitored with 2-2.5 MHz TCD (Embo-Dop, DWL) over the middle cerebral artery unilateral to stent deployment. Sonographers insured optimal signal recordings during the procedures. Automated emboli detection and classification software (MultiXLab version 2.0) was applied for offline count and analysis. Monitoring using the Filter Wire EX (Boston Scientific) and ACCUNET system (Guidant Corporation) was performed. Results: A total of 9,649 embolic signals were detected during 11 angiographic and 10 stenting procedures. An observer confirmed the signals using the International Consensus definition. Automated software classified these events into 5,900 gaseous and 3,749 solid emboli. During contrast injections without the protection device, 1,013 emboli were detected with 28% of these being solid. With deployment of the distal protection device, 8,636 emboli were found with 40% being solid (p < 0.001). During stenting and angioplasty with the protection device, 7,395 emboli with 42% solids were detected (p < 0.001). Finally injection of contrast after the procedure, with the protection device still deployed, yielded 1,241 emboli with 31% solids (NS). Only 1 patient developed transient hemiparesthesia during ballooning that reduced the flow velocity to zero for 14 s. Neither gaseous nor solid emboli resulted in a mean flow velocity decrease or clinical symptoms. Conclusions: Microembolization frequently occurs during stenting even with deployment of the distal protection device. More solid emboli are seen during manipulations associated with lesion crossing. Although novel TCD methods yield a high frequency of embolic signals, further validation of this technique to determine the true nature, size, and number of emboli is needed.

Original languageEnglish (US)
Pages (from-to)223-228
Number of pages6
JournalCerebrovascular Diseases
Volume21
Issue number4
DOIs
StatePublished - Mar 1 2006

Fingerprint

Embolism
Equipment and Supplies
Software
Injections
Middle Cerebral Artery
Angioplasty
Stents
Angiography
Technology

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Analysis of emboli during carotid stenting with distal protection device. / Chen, Chin I.; Iguchi, Yasuyuki; Garami, Zsolt; Malkoff, Marc; Smalling, Richard W.; Campbell, Morgan S.; Alexandrov, Andrei.

In: Cerebrovascular Diseases, Vol. 21, No. 4, 01.03.2006, p. 223-228.

Research output: Contribution to journalArticle

Chen, Chin I. ; Iguchi, Yasuyuki ; Garami, Zsolt ; Malkoff, Marc ; Smalling, Richard W. ; Campbell, Morgan S. ; Alexandrov, Andrei. / Analysis of emboli during carotid stenting with distal protection device. In: Cerebrovascular Diseases. 2006 ; Vol. 21, No. 4. pp. 223-228.
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abstract = "Background: The newly developed multi-frequency transcranial Doppler (TCD) is able to differentiate gaseous from solid emboli. Our goal was to apply this technology to initially characterize emboli detected during carotid stenting with distal protection. Methods: Patients undergoing carotid angiography and stenting were monitored with 2-2.5 MHz TCD (Embo-Dop, DWL) over the middle cerebral artery unilateral to stent deployment. Sonographers insured optimal signal recordings during the procedures. Automated emboli detection and classification software (MultiXLab version 2.0) was applied for offline count and analysis. Monitoring using the Filter Wire EX (Boston Scientific) and ACCUNET system (Guidant Corporation) was performed. Results: A total of 9,649 embolic signals were detected during 11 angiographic and 10 stenting procedures. An observer confirmed the signals using the International Consensus definition. Automated software classified these events into 5,900 gaseous and 3,749 solid emboli. During contrast injections without the protection device, 1,013 emboli were detected with 28{\%} of these being solid. With deployment of the distal protection device, 8,636 emboli were found with 40{\%} being solid (p < 0.001). During stenting and angioplasty with the protection device, 7,395 emboli with 42{\%} solids were detected (p < 0.001). Finally injection of contrast after the procedure, with the protection device still deployed, yielded 1,241 emboli with 31{\%} solids (NS). Only 1 patient developed transient hemiparesthesia during ballooning that reduced the flow velocity to zero for 14 s. Neither gaseous nor solid emboli resulted in a mean flow velocity decrease or clinical symptoms. Conclusions: Microembolization frequently occurs during stenting even with deployment of the distal protection device. More solid emboli are seen during manipulations associated with lesion crossing. Although novel TCD methods yield a high frequency of embolic signals, further validation of this technique to determine the true nature, size, and number of emboli is needed.",
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