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Is there any evidence that cerebral protection is beneficial? : Experimental data
This article presents the available experimental data from the world literature on the use of cerebral protection devices during carotid artery stenting (CAS). Clinical studies relying on surrogate markers of cerebral embolisation in place of neurological event rate as primary outcome measures are evaluated alongside benchtop and animal studies. These surrogate markers include evaluations of outcomes using procedural transcranial Doppler (TCD) and diffusion-weighted magnetic resonance imaging of brain (DwI). Pathological analyses of debris retrieved from in-vivo analyses of protection devices are also included in this review because although the focus of these studies was primarily clinical, the laboratory data will be preferentially presented and it provides interesting insights. It can be shown that each of the three philosophies of cerebral protection, namely flow arrest (proximal or distal), flow reversal and distal nitration is capable of the entrapment of sizeable debris that would logically threaten devastating stroke if it embolized to the brain. Whilst balloon occlusion significantly reduces the procedural microembolic load (particles less than 60 μm) and flow reversal may be the first means to entirely eliminate it, filters may be associated with increased microembolization. This has been described by some workers as controlled embolization. Certainly, particles smaller than the pore size of currently available filters (60-140 μm) will readily evade capture due to
Minerva medica
PMID : 16572086 ISSN : 0021-9509
Journal of cardiovascular surgery A. 2006, vol. 47, n° 2, pp. 127-136 [10 pages]
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