Significance of blood aspiration in carotid artery stenting with Angioguard XP

J Vasc Surg. 2011 Jun;53(6):1478-84. doi: 10.1016/j.jvs.2011.02.009. Epub 2011 Apr 23.

Abstract

Background and purpose: In some patients, angiographic flow impairment is observed during carotid artery stenting (CAS) using Angioguard XP (AGXP), resulting in neurological symptoms. CAS was thus modified to improve clinical outcome.

Methods: Ninety-seven patients were treated with CAS using AGXP from January 2008 to October 2009. In period I (January-December 2008; n = 53), blood aspirations were performed only in no-flow cases. In period II (January-October 2009; n = 44), blood aspirations were performed in no-flow and slow-flow cases. Clinical outcome, detection of microembolic lesions on diffusion-weighted imaging (DWI) and flow impairment during CAS were examined between these two periods before and after modifying the CAS procedure.

Results: Periprocedural transient ischemic attacks occurred in 10 patients (18.9%) and one patient (2.27%) in periods I and II, respectively (P = .018). Minor and major strokes were observed in two patients in each period (P = .849). New ipsilateral DWI lesions were detected in 25 patients (47.2%) and 11 patients (25.0%) in periods I and II, respectively (P = .024). Among 18 slow-flow cases, new DWI lesions were detected in one patient (9.09%) and five patients (71.4%) with (n = 11) and without (n = 7) blood aspirations, respectively (P = .013). Neurological symptoms were observed only in three of seven patients (42.9%) without aspirations, compared to one of 11 patients (9.1%) with aspirations (P = .043).

Conclusion: Postoperative symptomatic stroke and new DWI lesions are significantly associated with blood flow impairment during CAS using AGXP. When flow impairment occurs, blood aspiration should be performed.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography
  • Blood Vessel Prosthesis Implantation
  • Carotid Arteries / physiopathology
  • Carotid Arteries / surgery*
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / surgery*
  • Embolism / complications
  • Embolism / diagnosis*
  • Embolism / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Regional Blood Flow
  • Stents
  • Stroke / etiology
  • Stroke / prevention & control*