PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

Incident and characteristics of debris stuck in a filter used for carotid stenting

Text of the abstract

Introduction: Internal carotid artery (ICA) stenosis can be treated invasively by antegrade stenting. Antegrade stenting can be performed using proximal or distal protection devices, or without the use of an embolic protection device. At the Heart and Vascular Centre, Semmelweis University, antegrade stenting is performed with the use of distal type embolic protection filter.
Aim: Our study aimed to determine the incidence of filter debris and to analyse the relationship between carotid plaque parameters, stent type and filter debris indicators to determine whether filter use is essential in all patients or whether it is sufficient to insert filters only when certain plaque/stent parameters are present.
Methods: 80 patients [54 men, 26 women; median (IQR) age: 70.3 (64.5-76.7) years] who underwent antegrade stenting for asymptomatic, significant (>70%) ICA stenosis of atherosclerotic origin between 2019 and 2021 at our clinic were used as the basis of our prospective study. We investigated cardiovascular risk factors, comorbidities, stenosis parameters [percentage (DSA), plaque echogenicity/surface area (ultrasound), length, calcification, localization (CTA)], stent types and filter debris characteristics (histological composition).
Results: Hypertension was the most common atherosclerotic risk factor (86.3%). Cardiovascular comorbidity was present in 37.5% of cases. The median (IQR) stenosis percentage was 90 (80-90)%. Echo-poor/mainly echo-poor plaque occurred in 17 (21.3%) and exulcerated plaque surface in 23 patients (28.8%). The median (IQR) lesion length was 15 (13-22.3) mm, severe calcification was observed in 14 (17.5%) cases, and 52.5% of plaques were localized at the level of the carotid bifurcation. Self-expanding stent was implanted in all patients (Wallstent: N=62, Roadsaver stent: N=18). Macro- or microscopic debris was found in the filter in 40 cases (50%). The filter debris was lime in 22 patients (27.5%), fibroblast in 3 (3.8%) and a combination of these or other (e.g. lymphocytes) in 15 (18.8%). Detection of filter debris did not show a correlation with any of the factors we investigated.
Conclusions: During ICA stenting, regardless of the extent of stenosis, plaque morphology and type of stent, debris is often trapped in the filter.
Funding: EFOP-3.6.3-VEKOP-16-2017-00009 project