Vol 26, No 2 (2020)
Case report
Published online: 2020-09-25
Retained neuroprotection filter after stenting of the internal carotid artery
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DOI: 10.5603/AA.2020.0014
Acta Angiologica 2020;26(2):72-75.
Abstract
Retained neuroprotection filter after carotid stenting (CAS) is an extremely rare complication. We report the
case of a 61-year old patient with an accidentally retained neuroprotection filter after urgent CAS. The patient
did not consent to open surgical removal of the retained basket. We did not observe any flow disturbances in
the filter and the patient remains asymptomatic in ten years follow-up. In some cases, the neuroprotection
filter left in the internal carotid artery may not cause cerebral flow disturbances or occlusion of the stent. In
case of the poor neurological or general condition of the patient, we can wait for its improvement or stenting.
Keywords: carotid stentingembolic protection filterretained neuroprotectionacute strokethrombolysis
References
- Zahn R, Ischinger T, Mark B, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Embolic protection devices for carotid artery stenting: is there a difference between filter and distal occlusive devices? J Am Coll Cardiol. 2005; 45(11): 1769–1774.
- Touzé E, Trinquart L, Felgueiras R, et al. Carotid Stenting Trialists’ Collaboration. Systematic review of the perioperative risks of stroke or death after carotid angioplasty and stenting. Stroke. 2009; 40(12): e683–e693.
- Cremonesi A, Castriota F, Secco GG, et al. Carotid artery stenting: an update. Eur Heart J. 2015; 36(1): 13–21.
- Kwon BJu, Han MH, Kang HS, et al. Protection filter-related events in extracranial carotid artery stenting: a single-center experience. J Endovasc Ther. 2006; 13(6): 711–722.
- Sorimachi T, Nishino K, Morita K, et al. Obstruction of pores in distal protection filters and angiographically-documented flow impairment during carotid artery stenting. J Endovasc Ther. 2010; 17(5): 661–670.
- Bonati LH, Dobson J, Featherstone RL, et al. International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015; 385(9967): 529–538.
- Featherstone RL, Dobson J, Ederle J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis. Health Technol Assess. 2016; 20(20): 1–94.
- Bonati LH, Fraedrich G. Carotid Stenting Trialists' Collaboration. Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosis--a pooled analysis of EVA-3S, SPACE and ICSS. Eur J Vasc Endovasc Surg. 2011; 41(2): 153–158.
- Lian X, Liu W, Li M, et al. Risk factors and complications associated with difficult retrieval of embolic protection devices in carotid artery stenting. Cardiovasc Intervent Radiol. 2012; 35(1): 43–48.
- Arai S, Ikeda H, Kawamo M, et al. Surgical Rescue Retrieval of a Filter Protection Device in Carotid Artery Stenting with Stent Deformation: Case Report and Literature Review. World Neurosurg. 2019; 122: 215–219.
- Coppi G, Moratto R, Veronesi J, et al. Carotid artery stent fracture identification and clinical relevance. J Vasc Surg. 2010; 51(6): 1397–1405.
- Chang CK, Huded CP, Nolan BW, et al. Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting. J Vasc Surg. 2011; 54(3): 685–690.
- Texakalidis P, Letsos A, Kokkinidis DG, et al. Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis. Cardiovasc Revasc Med. 2018; 19(5 Pt A): 545–552.
- Cremonesi A, Manetti R, Setacci F, et al. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003; 34(8): 1936–1941.
- Daugherty WP, White JB, Cloft HJ, et al. Rescue retrieval of AngioGuard embolic capture system after failure of capture sheath retrieval in carotid angioplasty and stenting. AJNR Am J Neuroradiol. 2008; 29(8): 1594–1595.
- Lee JH, Youn SW, Kim HoK. Locking between a cerebral protection device and a stent-delivering catheter during carotid artery stenting. Interv Neuroradiol. 2014; 20(1): 100–105.
- Shilling K, Uretsky BF, Hunter GC. Entrapment of a cerebral embolic protection device--a case report. Vasc Endovascular Surg. 2006; 40(3): 229–233.
- Page P, Niemann D, Son C, et al. Retained distal protection device during carotid artery stenting necessitating carotid endarterectomy: A complication and management considerations. Surg Neurol Int. 2018; 9: 123.
- Li T, Zha Y, Bo L, et al. Surgical management for retained distal embolic protection device and fractured guidewire after carotid artery stenting. J Surg Case Rep. 2016; 2016(6).
- Gray WA, Hopkins LN, Yadav S, et al. ARCHeR Trial Collaborators. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006; 44(2): 258–268.