J Korean Neurosurg Soc.  2013 Mar;53(3):155-160. 10.3340/jkns.2013.53.3.155.

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

• Kwon SM
• Cheong JH
• Lee SK
• Park DW
• Kim JM
• Kim CH

• KMID: 2190745
• DOI: http://doi.org/10.3340/jkns.2013.53.3.155

Abstract

OBJECTIVE
The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events.
METHODS
A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group.
RESULTS
Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS.
CONCLUSION
In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.

Keyword

Risk factors; Microemboli; Carotid artery stenosis; Stent; Embolic protection device

MeSH Terms

Carotid Arteries
Carotid Stenosis
Embolic Protection Devices
Humans
Retrospective Studies
Risk Factors
Smoke
Smoking
Stents
Stroke
Smoke

Figure

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  Fig. 1 Lateral carotid angle is measured by angle between A and B.

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  Fig. 2 Microscopic findings of the embolic protection devices after procedure. Arrows indicate the emboli captured. A : Grade 1. No emboli are visible. B : Grade 2. One small embolus is seen. C : Grade 3. Many clots not exceeding 3 mm are seen. D : Grade 4. Large clots over 3 mm are captured by the embolic protection device.

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