J Cerebrovasc Endovasc Neurosurg.  2024 Jun;26(2):163-173. 10.7461/jcen.2024.E2023.10.001.

Flow arrest during carotid artery stenting with a distal embolic protection device: A single-center experience and clinical implications

• Hong N
• Park JM
• Kim SB
• Son YJ

• KMID: 2556978
• DOI: http://doi.org/10.7461/jcen.2024.E2023.10.001

Abstract

Objective
We aimed to investigate the incidence of flow arrest during carotid artery stenting (CAS) with filter-type embolic protection device (EPD), identify any predisposing factors for those situations, and contemplate intraprocedural precautionary steps.
Methods
CAS was performed in 128 patients with 132 arteries using filter-type EPD. The characteristics of treated patients and arteries were compared between groups with and without flow arrest.
Results
The incidence of flow arrest during CAS with filter-type EPD was 17.4%. In flow arrest group, cases of vulnerable plaques (p=0.02) and symptomatic lesions (p=0.01) were significantly more common, and there were more cases of debris captured by EPD in a planar pattern (p<0.01). Vulnerable plaques were significantly more common in the procedures showing a planar pattern than in the cases with other patterns (p<0.01). Flow arrest group showed a significantly higher rate of ischemic complications (p<0.05), although there were no significant periprocedural neurological changes. The planar pattern of captured debris in filter-type EPD was the only significant risk factor for flow arrest (adjusted odds ratio 88.44, 95% confidence interval 15.21-514.45, p<0.05).
Conclusions
Flow arrest during CAS with filter-type EPD is not uncommon and associated with increased ischemic complications. Symptomatic stenoses and vulnerable plaque are related to this event. The planar pattern of captured debris on the EPD was the only significant risk factor for the flow arrest. Clinicians must pay attention to the occurrence of flow arrest and react quickly when performing CAS.

Keyword

Carotid artery stenosis; Embolic protection devices; Endovascular procedures

Figure

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  Fig. 1. The gross pictures for the examples of patterns of captured debris on filter-type embolic protection devices. (A) shows the scattered pattern, and (B) demonstrates a planar pattern of debris, which was the case of flow arrest.

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