Peripheral Vascular Disease
Carotid angioplasty under cerebral protection with the percusurge guardwire system
Michel Henry MD,
Antonios Polydorou MD,
Isabelle Henry MD, Adamantia Polydorou MD,
Michel Hugel,
Corresponding Author
Michel Henry MD
Cabinet de CardioLogie, Nancy, France
Global Research Institute, Apollo Clinic, Hyderabad, India
80 rue Raymond Poìncaré, 54000 Nancy, FranceSearch for more papers by this authorAntonios Polydorou MD
General Hospital St. Panteleimon, Athens, Greece
Search for more papers by this authorAdamantia Polydorou MD
General Hospital St. Panteleimon, Athens, Greece
Search for more papers by this authorMichel Hugel
Cabinet de CardioLogie, Nancy, France
Global Research Institute, Apollo Clinic, Hyderabad, India
Search for more papers by this authorMichel Henry MD,
Antonios Polydorou MD,
Isabelle Henry MD, Adamantia Polydorou MD,
Michel Hugel,
Corresponding Author
Michel Henry MD
Cabinet de CardioLogie, Nancy, France
Global Research Institute, Apollo Clinic, Hyderabad, India
80 rue Raymond Poìncaré, 54000 Nancy, FranceSearch for more papers by this authorAntonios Polydorou MD
General Hospital St. Panteleimon, Athens, Greece
Search for more papers by this authorAdamantia Polydorou MD
General Hospital St. Panteleimon, Athens, Greece
Search for more papers by this authorMichel Hugel
Cabinet de CardioLogie, Nancy, France
Global Research Institute, Apollo Clinic, Hyderabad, India
Search for more papers by this authorAbstract
The purpose of this study was to examine the possible beneficial effect of the PercuSurge GuardWire cerebral protection device based on balloon occlusion of the distal internal carotid artery and debris aspiration for patients undergoing carotid artery stenting (CAS). A total of 268 CAS procedures were attempted under cerebral protection using the PercuSurge GuardWire system in 242 patients (194 men; mean age, 71.2 ± 9.4 years; range, 40–91). The lesions were mainly atherosclerotic; 64% were symptomatic. Technical success was 99.3%. All lesions were stented except three postangioplasty restenoses. Prophylactic occlusion during balloon dilatation and stenting was well tolerated in 255 patients (95.9%). Microscopic analysis of the aspirated blood showed different types of particles numbering between 7 and 145 per procedure, with a mean diameter of 250 μm (mean, 56–2,652 μm). The 30-day stroke and death rate was 2.3%, with four periprocedural complications at < 48 hr (one retinal embolism and three transient ischemic attacks), one intracerebral hemorrhage at 3 days, and one death of cardiac failure at 3 weeks. This technique appears safe and efficient with a low rate of periprocedural embolic events. Protection devices seem indispensable to perform CAS and expand the applicability of the procedure. Randomized studies (surgery vs. CAS with and without cerebral protection) are awaited. Catheter Cardiovasc Interv 2004;61:293–305. © 2004 Wiley-Liss, Inc.
REFERENCES
- 1 North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of the carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–453.
- 2 European Carotid Surgery Trialists' Ccollaborative group. MRC European carotid surgery trial: interim results for symptomatic patients with severe (70–90%) or with mild (0–29%) carotid stenosis. Lancet 1991; 337: 1235–1243.
- 3 Executive Committee for Asymptomatic Carotid Atherosclerotic Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421–1428.
- 4 Lusby RJ, Wylie EJ. Complications of carotid endarterectomy. Surg Clin North Am 1983; 63: 1293–1301.
- 5 Rothwell PM, Slatterg J, Waslow CP. A systematic review of the risks of stroke or deathdue to endarterectomy for symptomatic carotid stenosis. Stroke 1996; 27: 260–265.
- 6 McCrory DC, Golstein LC, Samsa GP, et al. Preducting complications of carotid endarterectomy. Stroke 1993; 24: 1285–1291.
- 7 American Heart Association. Heart and stroke facts: 1996 statistical supplement. Dallas, TX: American Heart Association; 1996.
- 8 Graor RA, Helzer NR. Management of coexistent carotid artery and coronary artery disease. Curr Concepts Cerebrovasc Dis Stroke 1988; 23: 19–23.
- 9 Newman DC, Hicks RG. Combined carotid and coronary artery surgery:a review of the literature. Ann Thorac Sur 1988; 45: 574–581.
- 10 Sundt TM Jr, Meyer FB, Piepgras DG, Fodee NC, Ebersold NJ, Marsh WR. Risk factors and operative results. In: FB Meyer, editor. Sundt's occlusive cerebrovascular disease, 2nd ed. Philadelphia: W.B. Saunders; 1994. p 241–247.
- 11 Link MJ, Meyer FB, Cherry KJ, Orszulak TA, Fode NC. Combined carotid and coronary revascularization. In: FB Meyer, editor. Sundt's occlusive cerebrovascular disease, 2nd ed. Philadelphia: W.B. Saunders; 1994. p 323–331.
- 12 Zierler RE, Brandyk DF, Thiele BL, Strandness ED. Carotid artery stenosis following endarterectomy. Arch Surg 1982; 117: 1408–1415.
- 13 Winslow CM, Solomon DH, Chassin MR, Kosekoff J, Merrick NJ, Brook RH. The appropriateness of carotid endarterectomy. N Engl J Med 1988; 318: 721–727.
- 14 Gaseeki AP, Eliaszio M, Ferguson GG, Hachinski V, Barnett HJ. Long term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral stenosis or occlusion: results from North American Symptomatic Carotid Endarterectomy Trial (NASCET) group. J Neurosurg 1995; 83: 778–782.
- 15 Ouriel K, Hertzer NR, Beven EG, et al. Preprocedural risks stratification: identifying an appropriate population for carotid stenting. J Vasc Surg 2001; 33: 728–732.
- 16 Yadav JS, Roubin GS, Iyer SS, et al. Elective stenting of the extracranial carotid arteries. Circulation 1997; 95: 376–381.
- 17 Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: initial experience in 110 patients. J Endovasc Surg 1996; 3: 42–46.
- 18 Roubin GS, Yadav S, Iyer S, Vitek J. Carotid stent-supported angioplasty: a neurovascular intervention to prevent stroke. Am J Cardiol 1996; 78(Suppl 3A): 8–12.
- 19 Henry M, Amor M, Masson I, et al. Angioplasty and stenting of the extracranial carotid arteries. J Endovasc Surg 1998; 5: 293–304.
- 20 Henry M, Amor M, Klonaris C, et al. Angioplasty and stenting of the extracranial carotid arteries. Tex Heart Inst J 2000; 27: 150–158.
- 21 Shawl F, Kadro W, Domanski MJ, et al. Safety and efficacy of elective carotid artery stenting in high-risk patients. J Am Coll Cardiol 2000; 35: 1721–1728.
- 22 Henry M, Amor M, Masson I, et al. Endovascular treatment of atherosclerotic stenosis of the internal carotid artery. J Cardiovasc Surg 1998; 39(Suppl 1): 141–150.
- 23 Roubin GS, New G, Iyer S, et al. Immediate and late clinical outcome of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis. Circulation 2001; 103: 532–537.
- 24 Wholey MH, Tan WA, et al. Management of neurological complication of carotid artery stenting. J Endovasc Ther 2001; 8: 341–353.
- 25 Cremonesi A, Castriota F, Manetti R, et al. Endovascular treatment of carotid atherosclerotic disease: early and late outcome in a non selected population. Ital Heart J 2000; 1: 801–809.
- 26
Gupta A,
Bhatia A,
Ahuja A, et al.
Carotid stenting in patients older than 65 years with ingerable carotid artery disease: a single center experience.
Catheter Cardiovasc Interv
2000;
50:
1–8.
10.1002/(SICI)1522-726X(200005)50:1<1::AID-CCD1>3.0.CO;2-R CAS PubMed Web of Science® Google Scholar
- 27 CAVATAS investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study. Lancet 2001; 357: 1729–1737.
- 28 Brooks WH, McLure RR, Jones MR. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 2001; 38: 1589–1595.
- 29 Vitek JJ, Raymon BC, Oh SJ. Innominate artery angioplasty. Am J Neuroradiol 1984; 5: 113–114.
- 30 Theron J, Raymon DJ, Casasio A, et al. Percutaneous angioplasty of atherosclerotic and postsurgical stenosis of carotid arteries. Am J Neuroradiol 1987; 8: 495–500.
- 31 Henry M, Amor M, Henry I, et al. Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg 1999; 6: 321–331.
- 31A Ahmadi R, Willfort A, Lang W, Schillinger M, Alt E, Gschwandtner ME, Haumer M, Maca T, Ehringer H, Minar E. Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome. J Endovasc Ther 2001; 8: 539–546.
- 32 Henry M, Henry I, Klonaris C, et al. Benefits of cerebral protection during carotid stenting with the PercuSurge GuardWire system: mid-term results. J Endovasc Ther 2002; 9: 1–13.
- 33 Theron J, Payelle G, Coskun O, Huet HF, Guimaraens L. Carotid artery stenosis: treatment with protected balloon angioplastey and stent placement. Radiology 1996; 201: 627–636.
- 34 Parodi JC, Lamura R, Ferreira LM, et al. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 2000; 32: 1127–1136.
- 35 AL Mubarak N, Roubin GS, Vitek JJ, et al. Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation 2001; 104: 1999–2002.
- 36 Mathias K, Jaeger M. How much cerebral embolization occurs during CAS? Miami: International Symposium on Endovascular Therapy; 2001. p 73–75.
- 37 Roubin GS. Carotid angioplasty and stenting under cerebral protection: the standard of care. Scottsdale: International Congress XV; 2002.
- 38 Schlueter M, Tuebler T, Haufe M, et al. Single center experience with balloon protected carotid artery stenting in 98 patients. Anaheim: American Heart Association meeting; 2001.
- 39 Mehran R, Roubin GS, New G, et al. Neurologic events after carotid stenting with distal protection using an occlusion balloon: final results from the Cafe USA trial. Anaheim: American Heart Association meeting; 2001.
- 40 Castriota F, Cremonesi A, Manetti R, et al. Carotid angioplasty and stenting with and without cerebral protection: single center experience in 275 consecutive patients. Scottsdale: International Congress XV; 2002.
- 41 Ohki T, Veith FJ. Carotid stenting with and without protection device: should protection be useful in all patients? Semin Vasc Surg 2000; 13: 144–152.
- 42 Ohki T, Roubin GS, Veith FJ, Iyer SS, Brady E. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: an ex-vivo analysis. J Vasc Surg 1999; 30: 1034–1044.
- 43 Reimers B, Corvaja N, Moshiris S, et al. Cerebral protection with filter devices during carotid artery stenting. Circulation 2001; 104: 12–15.
- 44 Roubin GS. Carotid angioplasty and stenting under cerebral protection: the standard of care. Scottsdale: International Congress XV; 2002
- 45 Biasi GM, Mingazzini PM, Baronio L, et al. Carotid plaque characterization using digital image processing and its potential in future studies of carotid endartererctomy and angioplasty. J Endovasc Surg 1998; 5: 240–246.
- 46 Biasi GM, Sampaolo A, Mingazzini P, De Amicis P, El-Barghouty N, Nicolaides AN. Computer analysis of ultrasonic plaque echolucency in identifying high risk carotid bifurcations lesions. Eur J Endovasc Surg 1999; 17: 476–479.
- 47 Biasi GM, Ferrari SA, Nicolaides AN, et al. The ICAROS registry of carotid artery stenting. J Endovasc Ther 2001; 8: 46–53.
- 48
Oesterle SN,
Hayase M,
Baim DS, et al.
An embolization containment device.
Catheter Cardiovasc Interv
1999;
47:
243–250.
10.1002/(SICI)1522-726X(199906)47:2<243::AID-CCD25>3.0.CO;2-Q CAS PubMed Web of Science® Google Scholar
- 49 Webb JG, Carere RG, Virmani R, et al. Retrieval and analysis of particulate debris adter saphenous vein graft intervention. J Am Coll Cardiol 1999; 34: 468–475.
- 50 Qureshi AL, Luft AR, Janardhan V, et al. Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting. Stroke 2000; 31: 376–382.
- 51 Reimers B, Castriota F, Corvaja N, et al. Carotid artery stent implantation with cerebral protection: a multicenter experience of 320 procedures. J Am Coll Cardiol 2002; 39(Suppl A): 30A.
- 52 Schönholz C. Filters as cerebral protection devices for cartoid angioplasty and stenting. In: M Henry, T Ohki, editors, Angioplasty and stenting of the carotid and supra aortic vessels. Textbook of peripheral vascular intervention. London: Martin Dunitz 2004 (in press).
- 53 Parodi JC, La Mure R, Ferreira L. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 2000; 32: 1127–1136.
- 54 Parodi JC. A new approach to cerebral protection. Miami: International Symposium on Endovascular Therapy (ISET) meeting; 2001.
- 55 Roubin GS. Carotid angioplasty and stenting: Lenox Hill experience. Washington: Transcatheter Cardiovascular Therapeutics (TCT) meeting; 2002.
- 56 Sievert H. Carotid angioplasty and stenting with the reversal flow technique: a multicenter experience. Frankfurt: Second International Course on Carotid Angioplasty; 2002.
