The use of embolic protection device in the stenting of brachiocephalic arteries

  • A.Yu. Polkovnikov Zaporizhzhia State Medical University
  • V.I. Pertsov Zaporizhzhia State Medical University
  • A.M. Materukhin Zaporizhzhia State Medical University
  • E.I. Savchenko Zaporizhzhia State Medical University
Keywords: ischemic stroke, stenosis of brachiocephalic arteries, stenting, embolic protection device.


Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries.

Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow.

Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted.

Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.


Download data is not yet available.


Hobzej NK, Mishhenko TS, Golik VA i dr. Osobennosti jepidemiologii invalidnosti pri zabolevanijah nervnoj sistemy v Ukraine (Rus). Mezhdunar. nevrol. zhurn. (Rus). 2011;5 (43):24-6.

Peterson B, Resnick S, Morasch M, Hassoun H, Eskandari M. Aortic arch vessel stenting. A single-center experience using cerebral protection. Arch. Surg. 2006; 141:563-4. doi:10.1001/archsurg.141.6.560

Bogousslavsky J, Van MG, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with firststroke. Stroke. 1988;19:1083-92. doi:10.11 61/01.STR. 19.9.1083

Crawley F, Clifton A, Buckenham T et al. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997;28:2460-4. doi: 10.1161/01.STR.28.12.2460

Przewlocki T, Kablak-Ziembicka A, Pieniazek P et al. Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Catheter Cardiovasc. Interv. 2006;67:519-26. doi: 10.1002/ccd.20695

Van der Vaart MG, Meerwaldt R, Reijnen MM et al. Endarterectomy or carotid artery stenting: the quest continues. Am. J. Surg. 2008;195:259-269. doi: 10.1016/j. amjsurg.2007.07.022.

Go AS, Mozaffrian D, Roger VL et al. Executive summary: Heart disease and stroke statistics – 2014 update: A report from the American Heart Association. Circulation 2014;129(3):399-410. doi: 10.1161/01. cir.0000442015.53336.12.

Jordan WD Jr, Voellinger DC, Doblar DD et al. Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc. Surg. 1999;7:33-8 doi:10.1016/S0967-2109(98)00097-0

Paukovits TM, Lukas L, Berczi V et al. Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions. Eur. J. Vasc Endovasc. Surg. 2010;40(1):35-43. doi: 10.1016/j. ejvs.2010.03.017.

Schneider PA, Ansel G. How do I select cerebral protection devices today? J. Cardiovasc. Surg. 2010;51:873-883.

How to Cite
Polkovnikov, A., Pertsov, V., Materukhin, A., & Savchenko, E. (2018). The use of embolic protection device in the stenting of brachiocephalic arteries. Ukrainian Interventional Neuroradiology and Surgery, 24(2), 44-51.