Department of Neurosurgery and Neuroradiology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Neuroradiology. 2010 Sep;52(9):831-6. doi: 10.1007/s00234-009-0630-8. Epub 2009 Dec 2.
We assessed the morphological change of calcified plaque after carotid artery stenting (CAS) in vessels with heavily calcified circumferential lesions and discuss the possible mechanisms of stent expansion in these lesions.
We performed 18 CAS procedures in 16 patients with severe carotid artery stenosis accompanied by plaque calcification involving more than 75% of the vessel circumference. All patients underwent multidetector-row computed tomography (MDCT) to evaluate lesion calcification before and within 3 months after intervention. The angiographic outcome immediately after CAS and follow-up angiographs obtained 6 months post-CAS were examined.
The preoperative mean arc of the calcifications was 320.1 +/- 24.5 degrees (range 278-360 degrees ). In all lesions, CAS procedures were successfully carried out; excellent dilation with residual stenosis <or=30% was achieved in all lesions. Post-CAS MDCT demonstrated multiple fragmentations of the calcifications in 17 of 18 lesions (94.4%), but only cracks in the calcified plaque without fragmentation in one (5.6%). Angiographic study performed approximately 6 months post-CAS detected severe restenosis in one lesion (5.6%) without fragmentation of calcified plaque.
Excellent stent expansion may be achieved and maintained in heavily calcified circumferential carotid lesions by disruption and fragmentation of the calcified plaques.
我们评估了重度环形颈动脉狭窄伴钙化病变患者颈动脉支架置入术（CAS）后钙化斑块的形态学变化，并探讨了支架在这些病变中扩张的可能机制。
我们对 16 例伴有严重颈动脉狭窄且斑块钙化累及超过 75%血管周径的患者进行了 18 例 CAS 手术。所有患者均进行了多排螺旋 CT（MDCT）检查，以评估介入治疗前后的病变钙化情况。术后即刻行血管造影检查，并在 CAS 术后 6 个月进行随访血管造影检查。
术前钙化的平均弧度为 320.1 +/- 24.5 度（范围 278-360 度）。所有病变均成功进行了 CAS 手术；所有病变均获得了极好的扩张，残余狭窄<or=30%。术后 MDCT 显示 18 个病变中有 17 个（94.4%）出现钙化的多个碎片，但只有一个病变（5.6%）出现钙化斑块的裂缝而无碎片。大约 6 个月后的血管造影研究发现一个病变（5.6%）有严重的再狭窄，而钙化斑块没有发生碎片。
通过破坏和碎裂钙化斑块，可实现并维持重度环形颈动脉狭窄病变中支架的良好扩张。
