Embolic risk of the different stages of carotid bifurcation balloon angioplasty: An experimental study

Purpose: Embolic events during carotid angioplasty are a challenging proble m. This experimental study was undertaken to determine the embolic risk aft er each stage of carotid angioplasty procedure. Methods: I;ive ex vivo carotid artery balloon angioplasties were performed an fresh carotid specimens. The carotid specimens were obtained from five p atients who underwent an internal carotid artery bypass for stenosis >75%. Before the endovascular maneuvers and after each stage of the procedures, t he specimens were flushed with 20 mL of saline solution. Small particulate emboli (diameter, <60 mu m) were searched in all the effluents according to the Coulter technique. After this procedure, each effluent tvas also submi tted to scanning electron microscopy. Results: When the stenosis was crossed with the guidewire or the balloon ca theter, the number and the mean diameter of embolic particles did not chang e with three plaques (CP1, CP2 and CP3) and were increased with two plaques (CP4 and CP5), The maximal size of particles was 220 mu m (CP5). After bal loon angioplasty, the number and the mean diameter of particles increased w ith CPI, CP2, and CP3. With CP4 and CP5, the number of particles decreased, but their size increased. The maximal size of particles particles was 1100 mu m (CP4). Conclusion: Carotid balloon angioplasty generates embolic particles after e ach stage of the procedure, Techniques of prevention should then be effecti ve from the initial step of the angioplasty procedure, and the selection of patients for carotid angioplasty remains crucial.