@article{3155656,
    title = "Association between Plaque Echogenicity and Embolic Material Captured in
Filter during Protected Carotid Angioplasty and Stenting",
    author = "Giannakopoulos, T. G. and Moulakakis, K. and Sfyroeras, G. S. and and Avgerinos, E. D. and Antonopoulos, C. N. and Kakisis, J. D. and and Karakitsos, P. and Brountzos, E. N. and Liapis, C. D.",
    journal = "European Journal of Vascular and Endovascular Surgery",
    year = "2012",
    volume = "43",
    number = "6",
    pages = "627-631",
    publisher = "W B SAUNDERS CO LTD",
    issn = "1078-5884, 1532-2165",
    doi = "10.1016/j.ejvs.2012.03.004",
    keywords = "Carotid stenting; Filter; Emboli; Debris; Plaque type",
    abstract = "Objectives/design: The aim of the study was to investigate debris
captured in filter embolic protection devices (EPDs) during carotid
artery stenting (CAS) and its possible correlation with plaque
echogenicity and other risk factors.
Materials/methods: Between June 2010 and March 2011, 51 consecutive CAS
patients (11 females, mean age 71.2 +/- 7, 10 symptomatic) who underwent
53 procedures were included in this prospective study. Ultrasonographic
Gray-Weale plaque type (I-V, echolucent to echogenic) characterisation
was obtained in all cases. The same type of stent and filter EPD was
used. Filters were collected and, after macroscopic evaluation, they
were examined using the Thin-Prep (R) liquid-based cytology (LBC)
technique.
Results: Technical success was 100%. Thirty-day stroke and death rates
were 1.8% (1/53) and 0%, respectively. Visible debris was detected in
eight (15%) filters, whereas LBC revealed the presence of embolic
material particles in 30 filters (56.6%). The presence of embolic
material into the filter EPD was 2.38-fold increased for every category
change from type IV to type I carotid plaques (OR = 2.38, 95% CI =
1.15-4.93). This association remained robust even after adjustment for
age, gender and known atherosclerotic disease risk factors (OR = 2.26,
95%CI = 1.02-5.02). In multivariate analysis for risk factors,
hypertension was associated with increased presence of embolic material
detection in filter EPD (OR = 20.4, 95%CI = 1.28-326.1). The time
distance from symptom to CAS was inversely correlated with debris
quantity in EPD (Spearman rho 0.716; p = 0.02).
Conclusions: Echolucent plaques, smaller time frame from last symptom
and hypertension were associated with increased presence of embolic
material. (C) 2012 European Society for Vascular Surgery. Published by
Elsevier Ltd. All rights reserved."
}