Determinants Of Embolization During Carotid Angioplasty And Stenting: Symptomaticity And Coronary Artery Disease Increase Embolic Risk
*Christine Chung, *Hyun Joo Shin, *Tejas Shah, Michael Marin, *Peter Faries
Mount Sinai, New York, NY
Objective: Patients at high risk for surgery have been routinely offered carotid angioplasty and stenting (CAS) as an alternative to endarterectomy for the treatment of severe carotid disease. However, the safety of CAS in this population continues to be a matter of debate, and appropriate patient selection for carotid interventions has emerged as the key to reducing adverse outcomes. Our goal is to determine whether the presence of coronary artery disease (CAD) is associated with greater embolic risk by analyzing debris from protective filters during CAS. Methods: 233 CAS procedures were performed between 2003-2009. Filters from 162 patients (CAD [N=86], non-CAD [N=76]) were quantified by stereomicroscopy and video imaging software. Results: Mean age of patients was 71.6 years, and 56.2% were male. Particulate debris was present in 134 (83%) filters. Univariate analysis revealed a greater number of particles in CAD patients than non-CAD patients (CAD: 12.6 ± 13.0 vs. non-CAD: 7.2 ± 7.8, p=.002). CAD patients had smaller mean (CAD: 351µm ± 216 vs. non-CAD: 429µm ± 429, p<.001) and minimum (CAD: 136µm ± 115 vs. non-CAD: 195µm ± 237, p<.001) particle sizes compared with non-CAD patients. Conclusions: Our study suggests that CAD is associated with increased embolic risk during CAS. CAD patients release a greater number of particles of smaller size that may pose increased neurologic risk by escaping capture by protection devices. Therefore, the benefits of a percutaneous carotid intervention must be carefully weighed against the potential for worse neurologic outcome in CAD patients referred for CAS.