Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492009000400005
Jornal Vascular Brasileiro
Original Article

Técnica para quantificação e qualificação de material coletado em filtros de proteção cerebral

Gabriel Santos Novaes; Álvaro Razuk Filho; Geanete Pozzan; Andrea Reis; Alexandre Fioranelli; Valter Castelli Jr.; Walter Khegan Karakhanian; Roberto Augusto Caffaro

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Resumo

Contexto: A qualidade e a quantidade de partículas coletadas em filtros de proteção cerebral (FPC) durante angioplastia transluminal percutânea com stent (ATPS) podem esclarecer a importância desses dispositivos no tratamento de estenoses carotídeas. Objetivos: Analisar o conteúdo retido por FPC em pacientes submetidos a ATPS de artéria carótida interna com nova técnica de análise qualiquantitativa. Métodos: O material coletado em 10 FPC durante ATPS da bifurcação da carótida em pacientes com alto risco cirúrgico foi submetido a análise microscópica qualiquantitativa. Fotografias digitais das lâminas com material corado com hematoxilina e eosina foram analisadas com o programa Axio Vision LE Release 4.1, que calculou a área das partículas em micrômetros/metro quadrado (µm²). Resultados: O exame histopatológico evidenciou material em 100% dos filtros consistindo predominantemente de restos hemáticos, cristais de colesterol e cálcio. A área média de fragmentos coletados foi expressiva (1.570.310 µm²), e houve ampla variância desses valores. Conclusões: Os FPC coletam quantidade importante de fragmentos de placas de ateroma, e a grande variância nas quantidades de material coletado pode estar associada com a gravidade da lesão, motivo pelo qual se tornam relevantes estudos que utilizem técnica padronizada para a quantificação desses fragmentos e para a compreensão de seu real significado clínico.

Palavras-chave

Artéria carótida, estenose carotídea, angioplastia transluminal percutânea com stent, filtros de proteção cerebral

References

Barnett HJ, Taylor DW, Eliasziw M. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415-25.

Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaboration. N Engl J Med. 1991;325:445-53.

MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. The European Carotid Surgery Trialists’ Collaborative Group. Lancet. 1991;337:1235-43.

Endarterectomy for moderate symptomatic carotid stenosis: interim results from de MRC European Carotid Surgery Trial. Lancet. 1996;347:1591-3.

Randomized trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379-87.

Sprouse LR 2nd, Peeters P, Bosiers M. The capture of visible debris by distal cerebral protection filters during carotid artery stenting: Is it predictable?. J Vasc Surg. 2005;41:950-5.

Yadav IS, Wholey MH, Kuntz RE. Protected carotid-artery stenting versus endarterectomy in high risk patients. N Engl J Med. 2004;351:1493-501.

Crawley F, Clifton A, Buckenham T, Loosemore T, Taylor RS, Brown MM. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997;28:2460-4.

Manninen HI, Rasanen HT, Vanninen RL, Vainio P, Hippeläinen M, Kosma VM. Stent placement versus percutaneous transluminal angioplasty of human carotid arteries in cadaver in situ: distal embolization and findings at intravascular. Radiology. 1999;212:483-92.

Parodi JC, Ferreira LM, Sicard G, La Mura R, Fernandez S. Cerebral protection during carotid stenting using flow reversal. J Vasc Surg. 2005;41:416-22.

Rapp JH, Wakil L, Sawhney RS. Subclinical embolization after carotid artery stenting: new lesions of diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg. 2007;45:867-72.

Bosiers M, de Donato G, Deloose K. Does free cell area influence the outcome in carotid artery stenting?. Eur J Vasc Edovasc Surg. 2007;33:135-41.

Burton KR, Lindsay TE. Assessment of short-term outcomes for protected carotid angioplasty with stents using recent evidence. J Vasc Surg. 2005;42:1094-100.

Mellière D. Carotid surgery: assessment and current problems. J Mal Vasc. 1993;18:176-85.

Ohki T, Marin NL, Lyon RT. Ex vivo human carotid artery bifurcation stenting: Correlation of lesion characteristics with embolic potential. J Vasc Surg. 1998;27:463-71.

Theron J, Courtheoux P, Alachkar F, Bouvard G, Maiza D. New triple coaxial catheter system for carotid angioplasty with cerebral protection. Am J Neuroradiol. 1990;11:869-74.

Angelini A, Reimers B, Della Barbera M. Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke. 2002;33:456-61.

Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stent: Clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003;34:1936-41.

Reimers B, Corvaja N, Moshiri S. Cerebral protection with filter devices during carotid artery stenting. Circulation. 2001;104:12-5.

Wholey MH, Wholey M, Mathias K. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Intervent. 2000;50:160-7.

DeRubertis BG, Chaer RA, Gordon R. Determining the quantity and character of carotid artery embolic debris by electron microscopy and energy dispersive spectroscopy. J Vasc Surg. 2007;45:716-25.

Maleux G, Demaerel P, Verbeken E. Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device. Am J Neuroradiol. 2006;27:1830-3.

Whitlow PL, Lylyk P, Londero H. Carotid artery stenting protected with an emboli containment system. Stroke. 2002;33:1308-14.

Müller-Hülsbeck S, Stolzmann P, Liess C. Vessel wall damage caused by cerebral protection devices: Ex vivo evaluation in porcine carotid arteries. Radiology. 2005;235:454-60.

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