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In vitro evaluation of the embolic risk of diagnostic and therapeutic intravascular procedures.

Katalin Zana, Philippe Otal, Bela Fornet, Gabor Forrai, Jean-Pierre Cambus, Valery Chabbert, Francis Joffre, Herve Rousseau

Med Sci Monit 2001; 7(1): MT148-152

ID: 421170

BACKGROUND: The purpose of the study was to evaluate the risk of distalembolisation in a silicon model during different endovascular diagnostic and therapeutic procedures.
MATERIAL AND METHODS: Endovascular technics, such as guidewire and catheter advancement, metal stentplacement and balloon angioplasty were compared. Clots were produced from human blood sample. The transparentsilicon model was filled with saline, flow was generated by an hydraulic pump. Stenosis was created bymechanical compression. The size of the circulating particles were measured with a mesh of nylon filters.
RESULTS: No loose particles were detected using guidewire, pigtail and straight catheters. Balloon inflationinduced embolisation of particles ranging from 100 microns to 10 mm in length. Deployment of self expandablemetallic stents did not result in particle migration but secondary angioplasty inside the stent detachedparticles (ranging from 400 microns to 12 mm in length). Deployment of balloon expandable stent yieldedin the stretching of the clot, which became sometimes longer than the stent, resulting in the detachmentof the non covered portion.
CONCLUSION: The risk of distal embolisation during guide-wires and cathetersmanipulation is not significant. Balloon catheters and secondary angioplasty after deployment of self-expandingstents caused large particles detachment.

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