Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Giannakopoulos Triantafyllos
Dissertation committee:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρήστος Λιάπης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ηλίας Μπρούντζος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ανδρέας Λάζαρης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρήστος Βερύκοκος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σταύρος Σπηλιόπουλος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ο ρόλος της εγκεφαλικής προστασίας στην ενδαγγειακή αντιμετώπιση της καρωτιδικής νόσου
Translated title:
The role of cerebral embolic protection devices during endovascular treatment of carotid disease
Summary:
OBJECTIVES: The aim of the study was to investigate debris captured in embolic protection devices (EPD) during carotid angioplasty and stenting (CAS) and its possible correlation with plaque echogenicity and other risk factors.
MATERIALS / METHODS: Between June 2010 and March 2011, 51 consecutive patients (11 females, mean age 71.2 +/-7, 10 symptomatic) who underwent 53 CAS procedures were included in this prospective study. Ultrasonographic Gray-Weale plaque type (I-V, echolucent to echogenic) characterization 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® liquid based cytology (LBC) technique. Additionally, a systematic review of the literature was performed for publications investigating brain microembolization during CAS from January 2010 to March 2016.
RESULTS: Technical success was 100%. Thirty-day stroke and death rates were 1.8% (1/53) and 0% respectively. Visible debris was detected in 8 (15%) filters, whereas liquid based cytology revealed embolic material in 30 filters (56.6%). The presence of emboli into the filter 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 remained robust even after adjustment for age, gender and known atherosclerosis risk factors (OR=2.26, 95%CI=1.02-5.02). In multivariate analysis for risk factors hypertension was associated with increased presence of emboli 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). Thirty-eight studies were retrieved and used for brain microembolization phenomenon analysis.
CONCLUSIONS: Echolucent plaques, smaller time frame from last symptom and hypertension were associated with increased presence of embolic material. Clinically silent brain microembolization occurs during CAS and requires further investigation.
Main subject category:
Health Sciences
Keywords:
Carotid angioplasty and stenting, CAS, Carotid disease, Carotid atheroma, Carotid plaque, Filter embolic protection devices, Embolic protection device, Embolic debris, Carotid stent, Endovascular carotid angioplasty, Carotid artery stenting, Liquid phase cytology, ThinPrep
Number of references:
123
