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Analysis of embolic atheromatous debris captured by cerebral protection devices: Correlation of clinical and histopathological characteristics using electron microscopy and energy dispersive spectroscopy
Author(s) -
Ramirez Daniel Emilio,
DeRubertis Brian G,
Hynecek Robert L,
Rhe Soo J,
Kent K Craig,
Faries Peter L
Publication year - 2007
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.21.5.a397
Subject(s) - medicine , carotid endarterectomy , debris , stenosis , stroke (engine) , platelet , carotid stenting , radiology , mechanical engineering , oceanography , engineering , geology
Cerebral protection devices have reduced the risk of embolic stroke during carotid artery stenting (CAS), a procedure that has been shown to effectively treat stenosis in patients at high risk for carotid endarterectomy. Embolic artheromatous debris captured in 64 filters during CAS (209 patients from 2003–2006) was collected and analyzed. Debris was found in 49 filters (77%), and was quantified by size, amount, morphology and composition. Particulate sizes were 200–500μm in 72%, 500–1000μm in 53%, and > 1000μm in 33% of cases. Twenty filters were analyzed by electron microscopy (EM) and energy dispersive spectroscopy (EDS) (9 symptomatic and 11 asymptomatic patients). EDS was used to quantify the calcium content within the debris. EM examination of the debris demonstrated sheets of red blood cells (RBC), activated platelets (P) with early evidence of fibrin crosslinking (F), cholesterol‐laden macrophages, and a large amount of acellular debris (image). The activated platelets were found more commonly with the symptomatic patients (100% vs. 33%). EDS identified no calcium within the debris, even in patients with calcified lesions on angiography. The debris captured during CAS demonstrated a higher amount of activated platelets in symptomatic patients. This analysis demonstrates a novel method to evaluate patient characteristics using embolic atheromatous debris collected intraoperatively.