• Proximal Protection Devices fo...

Treffer: Proximal Protection Devices for Carotid Artery Stent Placement: A Benchtop Assessment of Flow Reversal Performance.

Title:
Proximal Protection Devices for Carotid Artery Stent Placement: A Benchtop Assessment of Flow Reversal Performance.
Authors:
Li J; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota.; Stroke Research (J.L.), Vall d'Hebron Research Institute, Barcelona, Spain., Bayraktar EA; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota bayraktar.esref@mayo.edu., Bilgin C; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota., Liu Y; Global Institute of Future Technology (Y.L.), Shanghai Jiao Tong University, Shanghai, China., Senol YC; Department of Neurologic Surgery (Y.C.S., R.K., W.B.), Mayo Clinic Rochester, Rochester, Minnesota., Cortese J; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota.; Department of Neurointerventional Radiology (NEURI Vascular Center) (J.C.), Bicetre University Hospital, Le Kremlin Bicetre, France., Kadirvel R; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota.; Department of Neurologic Surgery (Y.C.S., R.K., W.B.), Mayo Clinic Rochester, Rochester, Minnesota., Brinjikji W; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota.; Department of Neurologic Surgery (Y.C.S., R.K., W.B.), Mayo Clinic Rochester, Rochester, Minnesota., Kallmes DF; From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota.
Source:
AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2025 Aug 01; Vol. 46 (8), pp. 1603-1608. Date of Electronic Publication: 2025 Aug 01.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: American Society of Neuroradiology Country of Publication: United States NLM ID: 8003708 Publication Model: Electronic Cited Medium: Internet ISSN: 1936-959X (Electronic) Linking ISSN: 01956108 NLM ISO Abbreviation: AJNR Am J Neuroradiol Subsets: MEDLINE
Imprint Name(s):
Publication: Oak Brook, IL : American Society of Neuroradiology
Original Publication: Baltimore, Williams & Wilkins.
MeSH Terms:
Stents* , Embolic Protection Devices* , Carotid Arteries*/surgery , Carotid Stenosis*/surgery , Models, Cardiovascular*, Humans ; Blood Flow Velocity/physiology ; Equipment Design ; Equipment Failure Analysis
Entry Date(s):
Date Created: 20250122 Date Completed: 20250801 Latest Revision: 20250924
Update Code:
20250924
PubMed Central ID:
PMC12453493
DOI:
10.3174/ajnr.A8664
PMID:
39843216
Database:
MEDLINE

Weitere Informationen

Background and Purpose: Proximal protection devices, such as TransCarotid Artery Revascularization (TCAR), aim to yield better outcomes in carotid artery stent placement (CAS) than distal protection devices by preventing plaque embolization to the brain. However, transfemoral catheters may not fully reverse flow from the external carotid artery (ECA) to the ICA. We assess a new balloon-sheath device, Femoral Flow Reversal Access for Carotid Artery Stent placement (FFRACAS), for this purpose.
Materials and Methods: The FFRACAS prototype (inner diameter [ID] = 0.117 inches; L = 80 cm) was compared with TCAR (ID = 0.104 inches, L = 30 cm) and Mo.Ma (ID = 0.083 inches, L = 90 cm) in a pulsatile flow model with blood simulant at 800 mL/min. Mo.Ma was used according to labeled instructions, with both CCA and ECA balloon inflation, without CCA-femoral vein shunt placement, and in an off-label fashion with single balloon occlusion in the CCA and shunt. Flow rates of the ICA, ECA, and shunt, when applicable, were monitored during CAS stages: CCA flow arrest, shunt activation, and stent delivery. Experiments were conducted under 2 ECA inflow conditions (-10 and -20 mL/min). Statistical comparison of ICA flow rates was conducted by using ANOVA and Tukey post hoc tests.
Results: The on-label use of Mo.Ma maintained retrograde ICA flow (-0.3 mL/min) throughout CAS. On shunt activation, TCAR and FFRACAS reversed ICA flow similarly under low ECA inflow (ICA = -5.10 mL/min versus -4.83 mL/min; P = .349), but neither achieved ICA flow reversal under high ECA inflow or during stent delivery. Mo.Ma off-label use failed to reverse ICA flow.
Conclusions: FFRACAS presents a potential alternative to TCAR, achieving similar degrees of flow reversal from a transfemoral approach to that achieved with the transcarotid approach. The Mo.Ma system reliably prevents anterograde flow in ICA during CAS.
(© 2025 by American Journal of Neuroradiology.)