Kuroiwa T, Sakai N, Sakaguchi M, Adachi H, Imamura H, Sakai C, Morizane A, Ishihara H, Yano T, Nakao S, Kikuchi H
Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation; Kobe, Hyogo, Japan.
Interv Neuroradiol. 2004 Dec 24;10 Suppl 2(Suppl 2):79-84. doi: 10.1177/15910199040100S215. Epub 2008 May 15.
The purpose of our experimental study was to assess the pitfalls of distal balloon protection systems and to learn any technique tips to increase safety. Silicone carotid artery models were connected to a circulatory system to simulate arterial flow. A distal balloon protection device, PercuSurge GuardWire Plus (GWP, Medtronic Vascular) was delivered to the internal carotid artery (ICA), then was inflated to occlude ICA flow temporarily. A debris aspiration catheter (Export catheter) was delivered just proximal to the GuardWire Plus balloon coaxially, in order to introduce and diffuse particulate debris (20-500micro meter in diameter) in the ICA stump. Then, after debris in the stump was aspirated, the GWP balloon was deflated. We recorded all the processes of our simulation experiments on a digital video and observed the movements of debris during these experiments. Exp 1) We simulated the movements of debris in the ICA stump when the GWP balloon was gradually deflated to produce a crevice between the balloon and vessel wall, simulating accidental movement of the GWP balloon during the procedure. Exp 2) In order to assess the optimal placement of the tip of aspiration catheter, the debris in the ICA stump was aspirated from three different sites(from just below the GuardWire balloon, from 2cm below it, and from 5cm below it). Exp 1) When the crevice appeared between GuardWire balloon and silicone tube, simulated debris began to concentrate just below the balloon. Then, some debris migrated distally from the crevice, and another part crowded in the crevice so that was impossible to aspirate and migrated in the end. Exp. 2) Debris aspiration was most effective from immediately below the GuardWire balloon, and the aspiration ability declined as the distance between the balloon and aspiration catheter became longer. According to our simulation studies, when the GWP balloon was moved accidentally during CAS procedures, or when the aspiration catheter was not delivered all the way to the GuardWire Plus balloon, distal embolization might still occur, even under protection.
我们实验研究的目的是评估远端球囊保护系统的缺陷，并学习提高安全性的技术要点。将硅胶颈动脉模型连接到循环系统以模拟动脉血流。将远端球囊保护装置PercuSurge GuardWire Plus（GWP，美敦力血管公司）输送至颈内动脉（ICA），然后充气以暂时阻断ICA血流。将一个碎栓抽吸导管（Export导管）同轴地输送至GuardWire Plus球囊近端，以便在ICA残端引入并扩散直径为20 - 500微米的颗粒碎片。然后，在抽吸残端的碎片后，将GWP球囊放气。我们在数字视频上记录了模拟实验的所有过程，并观察了这些实验过程中碎片的运动情况。实验1）我们模拟了当GWP球囊逐渐放气，在球囊与血管壁之间产生缝隙时，ICA残端碎片的运动情况，模拟手术过程中GWP球囊的意外移动。实验2）为了评估抽吸导管尖端的最佳放置位置，从三个不同位置（GuardWire球囊下方、其下方2厘米处和下方5厘米处）抽吸ICA残端的碎片。实验1）当GuardWire球囊与硅胶管之间出现缝隙时，模拟碎片开始集中在球囊下方。然后，一些碎片从缝隙向远端迁移，另一部分则聚集在缝隙中，以至于无法抽吸，最终也发生了迁移。实验2）从GuardWire球囊正下方进行碎片抽吸最为有效，随着球囊与抽吸导管之间距离的增加，抽吸能力下降。根据我们的模拟研究，在颈动脉支架置入术（CAS）过程中，当GWP球囊意外移动，或者抽吸导管未完全输送至GuardWire Plus球囊时，即使在有保护的情况下，远端栓塞仍可能发生。
