Role of the distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement

Background and Purpose - We sought to quantitatively and qualitatively evaluate the release of atheromatous plaque debris induced by carotid stenting procedures. Methods - Eight patients with severe carotid atheromatous stenoses were treated by stent implantation under distal balloon protection. Blood samplings were obtained after stent deployment in the blood pooled below the inflated protection balloon. The samples were centrifuged and evaluated for plaque debris with the use of light microscopy. The debris release was quantitatively estimated by dividing the total volume of debris obtained by the mean debris size. Five patients without endovascular procedure were used as a control group. Results - The 2 main debris types found were nonrefringent cholesterol crystals (4 to 389 μm; 115 to 8697 in number) and lipoid masses (7 to 600 μm; 341 to 34 000 in number). There was a statistically significant difference compared with the samples obtained in the control group (P=0.017). Conclusions - Blood samples collected during stent implantation procedures contain a large quantity of atheromatous plaque debris. This emphasizes the role of distal protection techniques in avoiding migration of this plaque material into the cerebral circulation.