Wall apposition assessment and performance comparison of distal protection filters

被引:35
作者
Finol, Ender A. [1 ,2 ]
Siewiorek, Gail M. [1 ]
Scotti, Christine M. [1 ]
Wholey, Michael H. [3 ]
Wholey, Mark H. [4 ]
机构
[1] Carnegie Mellon Univ, Dept Biomed Engn, Pittsburgh, PA 15213 USA
[2] Carnegie Mellon Univ, Inst Complex Engn Syst, Pittsburgh, PA 15213 USA
[3] Univ Texas Hlth Sci Ctr San Antonio, Dept Radiol, San Antonio, TX 78229 USA
[4] Univ Pittsburgh, Med Ctr Shadyside, Pittsburgh Vasc Inst, Dept Radiol, Pittsburgh, PA USA
关键词
cerebral protection device; embolization; carotid artery; stent; in vitro experiment; biofluids;
D O I
10.1583/07-2272.1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: To assess the wall apposition of 3 distal protection filters used in carotid artery stenting (CAS) for cerebral protection and quantify the effect on the in vitro capture efficiency of the filters under simulated physiological flow conditions. Methods: The 3 distal protection filters (Angioguard XP, FilterWire EZ, and RX Accunet) were deployed in silicone flow models of 5.0-, 5.5-, and 6.0-mm inner diameter and were tested at a mean flow rate characteristic of the human internal carotid artery while injecting polydispersed microspheres simulating plaque emboli. The injected microspheres had a diameter larger than the pore size of the devices tested, so it was conjectured that any microspheres missed by the device traveled between the device basket and the vessel wall. Varying the diameter of the vessel phantom within the recommended vessel diameter treatment range for each device simulated the variability of vessel diameter in vivo, allowing the quantification of device wall apposition. Results: None of the devices tested completely prevented distal embolization in the flow model. The RX Accunet device has the best overall wall apposition, yielding gaps of 0.075% of the vessel cross-sectional area. The FilterWire EZ device had the best overall average filtration rate, failing to capture only 0.8% of plaque particles. There were no statistically significant differences in the wall apposition assessment or the capture efficiency of the FIX Accunet and FilterWire EZ devices. Conclusion: Several complications related to apposition of the filter basket on the vessel wall and device retrieval were detected in all the devices. It is inferred that the adaptability of the filter basket to conform to the vessel cross section at the site of deployment is the primary design variable responsible for distal embolization during CAS with cerebral protection.
引用
收藏
页码:177 / 185
页数:9
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