Background: Quality and quantity of the content retained in embolic protection filters (EPFs) used in percutaneous transluminal angioplasty and stenting may possibly indicate the importance of EPFs in the management of carotid stenosis. Objectives: To analyze the content retained by EPFs in patients undergoing percutaneous transluminal angioplasty and stenting of the internal carotid artery using a new technique for qualitative and quantitative analysis. Methods: Material captured in 10 EPFs during percutaneous transluminal angioplasty and stenting in high-surgical-risk patients was examined to determine a qualitative and quantitative microscopic analysis. Digital photographs of the hematoxylin-eosin stained slides were analyzed using the Axio Vision LE Release 4.1 software in order to calculate the particles area in micra/square meter (µm²). Results: Histopathological examination identified particulate debris in 100% of the filters including predominantly blood residues, cholesterol crystals, and calcium Quantity of captured fragments was significant (mean of 1,570,310 µm²) with a wide range of these values. Conclusions: Significant quantity of fragments of atheromatous plaques is retained by EPFs and the wide range in the quantity of the retained debris can be associated with the lesion severity; therefore new studies using standardized technique for quantifying these fragments and for better understanding their real clinical meaning are necessary.
Carotid artery; carotid stenosis; percutaneous transluminal angioplasty and stenting; embolic protection filters
