Hayashi Kentaro, Kitagawa Naoki, Morikawa Minoru, Hiu Takeshi, Morofuji Yoichi, Suyama Kazuhiko, Nagata Izumi
Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
No Shinkei Geka. 2008 Dec;36(12):1133-8.
The SAPPHIRE trial has established carotid artery stenting (CAS) in high-surgical-risk patients as an effective alternative to carotid endarterectomy. Since the occurrence of distal embolization with CAS is still a major concern, an embolus protection device is usually employed during the procedure. Although the advantage of the filter device is continuation of blood flow during the procedure, blood flow is occasionally reduced due to plaque debris or thrombus. Here, we report a case of internal carotid artery (ICA) stenosis complicated with filter obstruction during CAS. A 74-year-old woman who had a history of coronary artery stenting was referred to our hospital for the treatment of carotid artery stenosis. Angiography showed occlusion of the right ICA and high-grade stenosis at the origin of the left ICA. Since cerebral circulation was impaired significantly in the left cerebral hemisphere, CAS was performed for the left ICA stenosis using an embolus protection filter. Self-expandable stent was placed into the left ICA following predilation. The patient developed consciousness disturbance and right hemiparesis during postdilation. Angiography showed impairment of blood flow, indicating filter obstruction. The debris containing blood stasis was removed with an aspiration catheter and the flow was restarted retrieving the filter. The symptom recovered within one hour. Appropriate antithrombotic therapy and preparation for filter obstruction such as the provision of an aspiration catheter are important in CAS using an embolus protection filter.
蓝宝石试验已证实，对于外科手术风险高的患者，颈动脉支架置入术（CAS）是颈动脉内膜切除术的一种有效替代方法。由于CAS术中远端栓塞的发生仍是一个主要问题，因此通常在手术过程中使用栓子保护装置。尽管滤器装置的优点是在手术过程中血流持续，但由于斑块碎片或血栓，血流偶尔会减少。在此，我们报告一例CAS术中颈内动脉（ICA）狭窄合并滤器阻塞的病例。一名有冠状动脉支架置入史的74岁女性因颈动脉狭窄被转诊至我院治疗。血管造影显示右侧ICA闭塞，左侧ICA起始处高度狭窄。由于左侧大脑半球脑循环明显受损，因此对左侧ICA狭窄采用栓子保护滤器进行CAS。预扩张后将自膨式支架置入左侧ICA。患者在扩张后出现意识障碍和右侧偏瘫。血管造影显示血流受损，提示滤器阻塞。用抽吸导管清除含有淤血的碎片，并取出滤器使血流重新恢复。症状在1小时内恢复。在使用栓子保护滤器的CAS中，适当的抗血栓治疗以及对滤器阻塞的准备工作（如提供抽吸导管）很重要。
