Flow Reversal for Cerebral Protection in Carotid Artery Stenting: A Review

Abstract

Carotid artery stenting has established itself as a valid treatment option for carotid stenosis. Many neuroprotective devices have been developed to minimize the risk of embolic events and stroke. Of the devices available today, flow reversal is unique in its conceptual similarity to carotid endarterectomy shunting techniques that maintain cerebral flow. This review focuses on the technical aspects, results, advantages, and disadvantages of carotid flow reversal for embolic protection during carotid artery stenting.

Keywords

flow reversal carotid artery stenting embolic protection devices

Get full access to this article

View all access options for this article.

References

Hasso AN , Bird CR , Zinke DE , Thompson JR Fibromuscular dysplasia of the internal carotid artery: percutaneous transluminal angioplasty. AJR Am J Roentgenol. 1981;136:955-960.

Motarjeme A. , Keifer JW , Zuska AJ Percutaneous transluminal angioplasty of the brachiocephalic arteries. AJR Am J Roentgenol. 1982;138:457-462.

Bockenheimer SA , Mathias K. Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNR Am J Neuroradiol. 1983;4:791-792.

Theron JG , Payelle GG , Coskun O. , Huet HF , Guimaraens L. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement. Radiology. 1996;201: 627-636.

Yadav JS , Roubin GS , King P. , Iyer S. , Vitek J. Angioplasty and stenting for restenosis after carotid endarterectomy. Initial experience. Stroke. 1996;27:2075-2079.

Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001 ;357:1729-1737.

Yadav JS , Wholey MH , Kuntz RE , et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-1501.

Faries PL , Dayal R. , Clair DG , et al. Continuity in the treatment of carotid artery disease: results of a carotid stenting program initiated by vascular surgeons. Ann Vasc Surg. 2004;18:669-676.

Derubertis BG , Chaer RA , Hynecek RL , Craig Kent K. , Faries PL Evolution of the treatment of carotid occlusive disease: indications for carotid angioplasty and stenting versus carotid endarterectomy . J Cardiovasc Surg (Torino). 2006;47:297-303.

10.

Goodney PP , Powell RJ Carotid artery stenting: what have we learned from the clinical trials and registries and where do we go from here? Ann Vasc Surg. 2008;22:148-158.

11.

Alberts MJ Results of a multicenter prospective randomized trial of carotid artery stenting vs carotid endarterecomy [abstract]. Stroke. 2001;32:325.

12.

Gray WH The ARCHeR trials: one year results. AHA Scientific Sessions ; 2004.

13.

Ahmadi R. , Willfort A. , Lang W. , et al. Carotid artery stenting : effect of learning curve and intermediate-term morphological outcome. J Endovasc Ther. 2001 ;8:539-546.

14.

Roubin GS , New G. , Iyer SS , et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis. Circulation. 2001;103:532-537.

15.

Shawl F. , Kadro W. , Domanski MJ , et al. Safety and efficacy of elective carotid artery stenting in high-risk patients. J Am Coll Cardiol. 2000;35:1721-1728.

16.

Yadav JS , Roubin GS , Iyer S. , et al. Elective stenting of the extracranial carotid arteries. Circulation. 1997;95: 376-381.

17.

DeRubertis BG , Chaer RA , Gordon R. , et al. Determining the quantity and character of carotid artery embolic debris by electron microscopy and energy dispersive spectroscopy. J Vasc Surg. 2007;45:716-724.

18.

Jordan WD Jr , Voellinger DC , Doblar DD , Plyushcheva NP , Fisher WS , McDowell HA Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy . Cardiovasc Surg. 1999;7:33-38.

19.

Jaeger HJ , Mathias KD , Drescher R. , et al. Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain. AJNR Am J Neuroradiol . 2001;22:1251-1259.

20.

du Mesnil de Rochemont R. , Schneider S. , Yan B. , Lehr A. , Sitzer M. , Berkefeld J. Diffusion-weighted MR imaging lesions after filter-protected stenting of high-grade symptomatic carotid artery stenoses . AJNR Am J Neuroradiol. 2006;27:1321-1325.

21.

Lacroix V. , Hammer F. , Astarci P. , et al. Ischemic cerebral lesions after carotid surgery and carotid stenting. Eur J Vasc Endovasc Surg. 2007;33:430-435.

22.

Rapp JH , Wakil L. , Sawhney R. , et al. Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure . Vasc Surg. 2007;45:867-872.

23.

Biasi GM , Froio A. , Diethrich EB , et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study . Circulation. 2004;110:756-762.

24.

Kastrup A. , Groschel K. , Krapf H. , Brehm BR , Dichgans J. , Schulz JB Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke. 2003;34: 813-819.

25.

Wholey MH , Al-Mubarek N. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003;60:259-266.

26.

Al-Mubarak N. , Roubin GS , Vitek JJ , Iyer SS , New G. , Leon MB Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation . 2001;104:1999-2002.

27.

Coggia M. , Goeau-Brissonniere O. , Duval JL , Leschi JP , Letort M. , Nagel MD Embolic risk of the different stages of carotid bifurcation balloon angioplasty: an experimental study. Vasc Surg. 2000;31:550-557.

28.

Henry M. , Amor M. , Henry I. , et al. Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg. 1999; 6:321-331.

29.

Henry M. , Henry I. , Polydorou A. , Polydorou AD , Le Borgne E. , Hugel M. Carotid angioplasty and stenting under cerebral protection with the PercuSurge GuardWire system. J Interv Cardiol. 2004; 17:233-243.

30.

Faries PL , DeRubertis B. , Trocciola S. , Karwowski J. , Kent KC , Chaer RA Ischemic preconditioning during the use of the PercuSurge occlusion balloon for carotid angioplasty and stenting. Vascular. 2008;16:1-9.

31.

Ohki T. , Veith FJ Critical analysis of distal protection devices. Semin Vasc Surg. 2003;16:317-325.

32.

Macdonald S. , Gaines PA Current concepts of mechanical cerebral protection during percutaneous carotid intervention. Vasc Med. 2003;8:25-32.

33.

Macdonald S. Is there any evidence that cerebral protection is beneficial? Experimental data. J Cardiovasc Surg (Torino) . 2006;47:127-136.

34.

Uflacker R. How to optimize carotid artery stenting. J Cardiovasc Surg (Torino). 2007;48:131-149.

35.

Parodi J. , La Mura R. , Ferreira LM , et al. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. Vasc Surg. 2000; 32:1127-1136.

36.

Ohki T. , Parodi J. , Veith FJ , et al. Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: an experimental analysis. Vasc Surg. 2001;33:504-509.

37.

Criado E. , Doblas M. , Fontcuberta J. , Orgaz A. , Flores A. Transcervical carotid artery angioplasty and stenting with carotid flow reversal: surgical technique. Ann Vasc Surg. 2004;18:257-261.

38.

Chang DW , Schubart PJ , Veith FJ , Zarins CK A new approach to carotid angioplasty and stenting with transcervical occlusion and protective shunting: why it may be a better carotid artery intervention . Vasc Surg. 2004;39:994-1002.

39.

Ohki T. , Veith FJ , Grenell S. , et al. Initial experience with cerebral protection devices to prevent embolization during carotid artery stenting. Vasc Surg. 2002;36:1175-1185.

40.

Adami CA , Scuro A. , Spinamano L. , et al. Use of the Parodi anti-embolism system in carotid stenting: Italian trial results. J Endovasc Ther. 2002 ;9:147-154.

41.

Bates MC , Molano J. , Pauley ME Internal carotid artery flow arrest/reversal cerebral protection techniques . W V Med J. 2004;100:60-63.

42.

Rabe K. , Sugita J. , Godel H. , Sievert H. Flow-reversal device for cerebral protection during carotid artery stenting-acute and long-term results. Interv Cardiol. 2006 ;19:55-62.

43.

Parodi JC , Schonholz C. , Parodi FE , Sicard G. , Ferreira LM Initial 200 cases of carotid artery stenting using a reversal-of-flow cerebral protection device. Cardiovasc Surg (Torino). 2007;48:117-124.

44.

Grunwald IQ , Papanagiotou P. , Struffert T. , et al. Reversal of flow during carotid artery stenting: use of the Parodi antiembolism system. Neuroradiology . 2007;49:237-241.

45.

Lin JC , Kolvenbach RR , Pinter L. Protected carotid artery stenting and angioplasty via transfemoral versus transcervical approaches. Vasc Endovascular Surg. 2005;39:499-503.

46.

Pipinos II , Bruzoni M. , Johanning JM , Mathew Longo G. , Lynch TG Transcervical carotid stenting with flow reversal for neuroprotection: technique, results, advantages, and limitations. Vascular. 2006;14:245-255.

47.

Ribo M. , Molina CA , Alvarez B. , Rubiera M. , Alvarez-Sabin J. , Matas M. Transcranial Doppler monitoring of transcervical carotid stenting with flow reversal protection : a novel carotid revascularization technique. Stroke. 2006;37:2846-2849.

48.

Criado E. , Fontcuberta J. , Orgaz A. , Florez A. , Doblas M. Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents. J Vasc Surg. 2007;46:864-869.

49.

Matas M. , Alvarez B. , Ribo M. , Molina C. , Maeso J. , Alvarez-Sabin J. Transcervical carotid stenting with flow reversal protection: experience in high-risk patients. J Vasc Surg. 2007;46:49-54.

50.

Alvarez B. , Ribo M. , Maeso J. , Quintana M. , Alvarez-Sabin J. , Matas M. Transcervical carotid stenting with flow reversal is safe in octogenarians: a preliminary safety study. J Vasc Surg. 2008 ;47:96-100.

51.

Rapp JH , Pan XM , Yu B. , et al. Cerebral ischemia and infarction from atheroemboli <100 microm in size. Stroke. 2003;34:1976-1980.

52.

Theron J. , Courtheoux P. , Alachkar F. , Bouvard G. , Maiza D. New triple coaxial catheter system for carotid angioplasty with cerebral protection . AJNR Am J Neuroradiol. 1990;11:869-874.

53.

Theron J. Protected carotid angioplasty and carotid stents. J Mal Vasc . 1996;21 (suppl A):113-122.

54.

Barbato JE , Dillavou E. , Horowitz MB , et al. A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg. 2008;47:760-765.

55.

Ouriel K. , Wholey MH , Fayad P. , et al. Feasibility trial of carotid stenting with and without an embolus protection device. J Endovasc Ther. 2005;12:525-537.

56.

Kastrup A. , Nagele T. , Groschel K. , et al. Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke. 2006;37:2312-2316.

57.

Rubartelli P. , Brusa G. , Arrigo A. , et al. Transcranial Doppler monitoring during stenting of the carotid bifurcation : evaluation of two different distal protection devices in preventing embolization. J Endovasc Ther. 2006;13:436-442.

58.

Henry M. , Polydorou A. , Henry I. , Hugel M. Carotid angioplasty under cerebral protection with the PercuSurge GuardWire System. Catheter Cardiovasc Interv. 2004;61:293-305.

59.

Powell RJ , Schermerhorn M. , Nolan B. , et al. Early results of carotid stent placement for treatment of extracranial carotid bifurcation occlusive disease. Vasc Surg. 2004;39:1193-1199.

60.

Parodi JC , Schonholz C. , Ferreira LM , Mendaro E. , Ohki T. " Seat belt and air bag" technique for cerebral protection during carotid stenting . J Endovasc Ther. 2002;9: 20-24.