TY - JOUR
T1 - Ex vivo human carotid artery bifurcation stenting
T2 - Correlation of lesion characteristics with embolic potential
AU - Ohki, T.
AU - Marin, M. L.
AU - Lyon, R. T.
AU - Berdejo, G. L.
AU - Soundararajan, K.
AU - Ohki, M.
AU - Yuan, J. G.
AU - Faries, P. L.
AU - Wain, R. A.
AU - Sanchez, L. A.
AU - Suggs, W. D.
AU - Veith, F. J.
N1 - Funding Information:
Supported by grants from the US Public Health Service (HL 02990-04), the James Hilton Manning and Emma Austin Manning Foundation, and Jikei University International Research Grant.
PY - 1998
Y1 - 1998
N2 - Purpose: To develop an ex vivo human carotid artery stenting model that can be used for the quantitative analysis of risk for embolization associated with balloon angioplasty and stenting and to correlate this risk with lesion characteristics to define suitable for balloon angioplasty and stenting. Methods: Specimens of carotid plaque (n = 24) were obtained circumferentially intact from patients undergoing standard carotid endarterectomy. Carotid lesions were prospectively characterized on the basis of angiographic and duplex findings before endarterectomy and clinical findings. Specimens were encased in a polytetrafluoroethylene wrap and mounted in a flow chamber that allowed access for endovascular procedures and observations. Balloon angioplasty and stenting were performed under fluoroscopic guidance with either a Palmaz stent or a Wallstent endoprosthesis. Ex vivo angiograms were obtained before and after intervention. Effluent from each specimen was filtered for released embolic particles, which were microscopically examined, counted, and correlated with various plaque characteristics by means of multivariate analysis. Results: Balloon angioplasty and stenting produced embolic particles that consisted of atherosclerotic debris, organized thrombus, and calcified material. The number of embolic particles detected after balloon angioplasty and stenting was not related to preoperative symptoms, sex, plaque ulceration or calcification, or artery size. However, echolucent plaques generated a higher number of particles compared with echogenic plaques (p < 0.01). In addition, increased lesion stenosis also significantly correlated with the total number of particles produced by balloon angioplasty and stenting (r = 0.55). Multivariate analysis revealed that these two characteristics were independent risk factors. Conclusions: Echolucent plaques and plaques with stenosis ≤90% produced a higher number of embolic particles and therefore may be less suitable for balloon angioplasty and stenting. This ex vivo model can be used to identify high- risk lesions for balloon angioplasty and stenting and can aid in the evaluation of new devices being considered for carotid balloon angioplasty and stenting.
AB - Purpose: To develop an ex vivo human carotid artery stenting model that can be used for the quantitative analysis of risk for embolization associated with balloon angioplasty and stenting and to correlate this risk with lesion characteristics to define suitable for balloon angioplasty and stenting. Methods: Specimens of carotid plaque (n = 24) were obtained circumferentially intact from patients undergoing standard carotid endarterectomy. Carotid lesions were prospectively characterized on the basis of angiographic and duplex findings before endarterectomy and clinical findings. Specimens were encased in a polytetrafluoroethylene wrap and mounted in a flow chamber that allowed access for endovascular procedures and observations. Balloon angioplasty and stenting were performed under fluoroscopic guidance with either a Palmaz stent or a Wallstent endoprosthesis. Ex vivo angiograms were obtained before and after intervention. Effluent from each specimen was filtered for released embolic particles, which were microscopically examined, counted, and correlated with various plaque characteristics by means of multivariate analysis. Results: Balloon angioplasty and stenting produced embolic particles that consisted of atherosclerotic debris, organized thrombus, and calcified material. The number of embolic particles detected after balloon angioplasty and stenting was not related to preoperative symptoms, sex, plaque ulceration or calcification, or artery size. However, echolucent plaques generated a higher number of particles compared with echogenic plaques (p < 0.01). In addition, increased lesion stenosis also significantly correlated with the total number of particles produced by balloon angioplasty and stenting (r = 0.55). Multivariate analysis revealed that these two characteristics were independent risk factors. Conclusions: Echolucent plaques and plaques with stenosis ≤90% produced a higher number of embolic particles and therefore may be less suitable for balloon angioplasty and stenting. This ex vivo model can be used to identify high- risk lesions for balloon angioplasty and stenting and can aid in the evaluation of new devices being considered for carotid balloon angioplasty and stenting.
UR - http://www.scopus.com/inward/record.url?scp=18844480615&partnerID=8YFLogxK
U2 - 10.1016/S0741-5214(98)70321-0
DO - 10.1016/S0741-5214(98)70321-0
M3 - Article
C2 - 9546231
AN - SCOPUS:18844480615
SN - 0741-5214
VL - 27
SP - 463
EP - 471
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 3
ER -