Courtesy of Dr. Carlos Fava.
Carotid artery stenting (CAS) with a cerebral protection system has emerged as an alternative to surgery, particularly for patients with high surgical risk.
Nowadays, there are a considerable number of cerebral protection systems, but these may sometimes fail due to anatomical issues, the diameter of embolized particles, or placement difficulties (among other reasons).
Proximal and distal protection systems have been developed, and they seem to offer additional benefits compared with traditional filters.
This study analyzed 106 patients who underwent CAS with the Paladin protection system, composed of a semi-compliant balloon and a nitinol filter protecting arteries up to 7 mm through a membrane with 40-µm pores.
Patient age was 70 years; most patients were male; 19.3% had diabetes, 36.3% had symptoms, 11.3% had prior acute myocardial infarction, 9.4% had prior myocardial revasculatization surgery, 15.1% had prior endarterectomy, and 5.7% had received neck radiation. Right CAS was more frequent.
Distal embolic protection was successful in 105 patients and there were no in-hospital events. At 30 days, only one patient experienced a stroke (probably unrelated to the procedure); there were no deaths or infarctions.
Magnetic resonance imaging showed new ischemic lesions in 11 patients and new ipsilateral lesions in another 9 patients. Lesion volume per patient was 0.01 cm3.
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Researchers analyzed 46 filters; debris was present in all of them. About 90% of all captured particles were smaller than 100 μm.
Conclusion
Use of the Paladin protection system during carotid artery stenting seems to be safe and, perhaps, very effective as regards the reduction of the number of embolic particles reaching the brain. Consequently, it may reduce the rates of procedure-related stroke.
Courtesy of Dr. Carlos Fava.
Original title: Double Filtration During Carotid Artery Stenting Using a Novel Post-Dilation Balloon with Integrated Embolic Protection.
Reference: Ralf Langhoff et al. J Am Coll Cardiol Intv 2019;12:395-403
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