Identification of the debris collected during carotid artery stenting, comparing with carotid endarterectomy specimen

  • HAYASHI Kentaro
    Department of Neurosurgery, Nagasaki University School of Medicine
  • HORIE Nobutaka
    Department of Neurosurgery, Nagasaki University School of Medicine
  • MORIKAWA Minoru
    Department of Radiology, Nagasaki University School of Medicine
  • SO Gohei
    Department of Neurosurgery, Nagasaki University School of Medicine
  • TAKESHITA Tomonori
    Department of Neurosurgery, Nagasaki University School of Medicine
  • SUYAMA Kazuhiko
    Department of Neurosurgery, Nagasaki University School of Medicine
  • NAGATA Izumi
    Department of Neurosurgery, Nagasaki University School of Medicine

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Other Title
  • 頚動脈ステント留置術中に回収されたデブリスの同定:頚動脈内膜剥離術病理標本と対比して
  • ケイドウミャク ステント リュウチ ジュッチュウ ニ カイシュウ サレタ デブリス ノ ドウ テイ : ケイドウミャク ナイマク ハクリジュツ ビョウリ ヒョウホン ト タイヒ シテ

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Abstract

Objective: Carotid artery stenting (CAS) in highsurgicalrisk patients is considered as an effective alternative to carotid endarterectomy (CEA). Since the occurrence of distal embolization with CAS is still a major concern, an embolus protection device is usually employed during the procedure. We examined the debris in the embolic protection filter and compared the characteristics of the debris with the characteristics of CEA specimens.<br>Materials and Methods: CAS was performed for 27 patients with carotid artery stenosis (28 lesions). After completing CAS, each filter membrane was stained with HematoxylinEosin (HE) solution, removed from the filter strut, mounted onto a glass slide, and evaluated under a microscope. Fortynine patients (49 lesions) were treated with CEA. Histopathological examination was performed with HE stain, Azan stain, and Elastica van Gieson stain. The characteristics of the debris were compared with those of the CEA specimens.<br>Results: HE stain facilitated the characterization of the debris. Microscopically, thrombotic debris, calcified debris, lipid-rich debris, fibrous debris, cellular debris, and strips of endothelium were observed.<br>Conclusion: Carotid plaque debris captured during carotid stenting with a protection filter can be visualized on the filter by HE staining. Almost all components of the carotid plaque are identifiable as debris.

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