The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting

• Published in: American journal of neuroradiology : AJNR Vol. 31; no. 9; pp. 1732 - 1736
• Main Authors: KIM, H. J, LEE, H. J, YANG, J. H, YEO, I. S, YI, J. S, LEE, I. W, LEE, S. B, RYU, S. Y, KIM, J. K, YANG, P. S
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01-10-2010
• Series: Editor's Choice
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood Vessel Prosthesis - statistics & numerical data; Cardiac Catheterization - statistics & numerical data; Carotid Stenosis - diagnosis; Carotid Stenosis - epidemiology; Carotid Stenosis - surgery; Diffusion Magnetic Resonance Imaging; Female; Humans; Incidence; Interventional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Republic of Korea - epidemiology; Risk Assessment; Risk Factors; Stents - statistics & numerical data; Thromboembolism - diagnosis; Thromboembolism - epidemiology; Treatment Outcome; Republic of Korea; Vascular disease; Nervous system diseases; Catheterization; Radiodiagnosis; Blood vessel; Carotid; Cardiovascular disease; Circulatory system; Technique; Thromboembolism; Artery; Incidence
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a2141

Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery.
Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, n = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, n = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups.
NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age (P = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery (P = .004) and the incidence of multiple NESs (P = .04) were significantly higher in group 1.
NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.