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In asymptomatic patients undergoing CAS, high filter debris load portends complications
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Among asymptomatic patients undergoing carotid artery stenting, those with a neurologic event had greater filter debris load than those who did not, researchers reported.
The researchers analyzed 278 patients who underwent CAS with distal filter protection between 2008 and 2016.
After each procedure, the researchers calculated the percentage of filter membrane occupied by debris, expressed as embolic filter debris load, and assessed the associations between embolic filter debris load and anatomic and clinical variables.
Among the cohort, there were no perioperative deaths, the rate of perioperative stroke was 1% (minor, 0.7%; major, 0.4%) and the rate of perioperative transient ischemic attack was 5.7%, Michele Piazza, MD, from Padua University, Italy, and colleagues wrote.
“Our objective was to identify a valid relation between debris quantity and clinical relevance. This became significant once the amount of debris covered > 12.5% of the filter surface,” Piazza said in a press release. “This is important because it may help identify those carotid plaques associated with a higher risk of embolization during the procedure, leading to a better selection of patients who may truly benefit from carotid stenting.”
According to the researchers, 74% of patients had some degree of embolic filter debris. Mean embolic filter debris load was 10% (median, 1%; range, 0-80).
Compared with those who did not have one, patients with a stroke or TIA after the procedure had a higher embolic filter debris load (26.7% vs. 8.5%; P < .001), Piazza and colleagues wrote.
The optimal cutoff for the association with clinically relevant perioperative ischemic events was an embolic filter debris load of 12.5% (sensitivity, 78%; specificity, 77%; area under the curve, 0.81), according to the researchers.
Piazza and colleagues also found that independent predictors of embolic filter debris load greater than 12.5% were age older than 75 years (OR = 2.56; P = .003), prior ipsilateral ischemic cerebral lesion (OR = 2.09; P = .04), presence of hypoechogenic plaque (OR = 6.05; P < .001) and plaque length greater than 15 mm (OR = 1.79; P = .04). – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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