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Erschienen in:
16.02.2018 | Original Article - Vascular
Predictors of antegrade flow at internal carotid artery during carotid artery stenting with proximal protection
Erschienen in: Acta Neurochirurgica | Ausgabe 6/2018
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Background
Carotid artery stenting (CAS) with proximal occlusion effectively prevent distal cerebral embolism by flow arrest at internal carotid artery (ICA); however, the method can expose antegrade flow at ICA due to incomplete flow arrest. The aim of this study was to identify predictors of antegrade flow during CAS with proximal protection.
Methods
We retrospectively analyzed clinical and angiographic data among 143 lesions treated with CAS with proximal protection by occluding the common carotid artery (CCA) and external carotid artery (ECA). Flow arrest or antegrade flow at ICA was confirmed by contrast injection during proximal protection.
Results
Antegrade flow at ICA was observed in 12 lesions (8.4%). Compared with lesions in which flow arrest of ICA was achieved, the diameter of the superior thyroid artery (STA) was significantly larger (2.4 ± 0.34 vs. 1.4 ± 0.68 mm, p < 0.001), and the rate of ECA branches other than the STA located 0–10 mm above the bifurcation was significantly higher (50 vs. 8.4%, p < 0.001). Results of multivariate analysis revealed that a diameter of the STA ≥ 2.3 mm (OR 44, 95% CI 8.1–237; p < 0.001) and ECA branches other than the STA located 0–10 mm above the bifurcation (OR 6.0, 95% CI 1.1–32; p = 0.036) were independent predictors of antegrade flow.
Conclusions
Distal filter protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.