Reduction of cerebral embolization in carotid angioplasty: an in-vitro experiment comparing 2 cerebral protection devices.

摘要

PURPOSE: To evaluate the efficiency of 2 distal filtration devices designed for cerebral protection during carotid angioplasty in an in-vitro bench-top model. METHODS: After positioning the respective protection devices (RX Accunet and DynaCap) 5 cm distal to the bifurcation, embolization from carotid angioplasty was simulated by injecting polyvinyl alcohol particles in groups of small (150 to 250-microm diameter, approximately 500 particles), medium (250 to 355-microm diameter, approximately 200 particles), and large (700 to 1000-microm diameter, approximately 80 particles). Five milligrams of each group were injected separately into the internal carotid artery (ICA) model proximal to the protection filters. Particles passing the protection devices were caught in 100-microm filters and weighed. RESULTS: For small particles, the amount in the effluent of the ICA was 0.34+/-0.12 mg (6.8%) for the RX Accunet and 0.51+/-0.16 mg (11.2%) for the Occam DynaCap (p<0.05). For the other particle sizes, there was no statistical difference between the filters (p>0.05). CONCLUSION: In all test runs, neither of the tested devices prevented embolization completely, with approximately 3% to 6% of particles penetrating. For small particles, the lowest amount of particles passing the protection device was achieved using the RX Accunet system.