Iatrogenic vasospasm in carotid artery stent angioplasty with distal protection devices.

Object Distal protection devices (DPDs) have decreased the risk of embolic stroke among patients with carotid artery (CA) disease undergoing CA stent placement. The FilterWire EX is a first-generation fixed-basket DPD with a filter rigidly attached to a guidewire. Second-generation mobile-basket DPDs (RX Accunet or SpiderFX) allow movement of the filter relative to the guidewire and can thus reduce the potential for vessel irritation, vasospasm, or intimal injury during CA stent placement. Methods Stent angioplasty was attempted in 40 CAs (37 patients) using the fixed-basket FilterWire DPD, a second-generation mobile-basket DPD, or no protection in 12, 6, and 22 arteries, respectively. Clinical presentation, angiographic details relating to the incidence of vasospasm or dissection, and clinical outcome data were recorded and analyzed. Results Vasospasm was associated with use of the fixed-basket FilterWire device (8 [67%] of 12 cases) compared with the bare unfiltered guidewire group (3 [14%] of 22) and t...