Harada Kei, Kakumoto Kousuke, Morioka Jun, Saito Tarou, Fukuyama Kouzou
Department of Neurosurgery, Fukuoka Wajiro Hospital Heart & Neuro-Vascular Center, Fukuoka, Japan.
Department of Neurosurgery, Fukuoka Wajiro Hospital Heart & Neuro-Vascular Center, Fukuoka, Japan.
Ann Vasc Surg. 2014 Apr;28(3):651-8. doi: 10.1016/j.avsg.2013.04.032. Epub 2013 Dec 28.
Carotid artery stenting (CAS) with distal filter protection allows continuous cerebral perfusion, although it is associated with a greater risk of cerebral ischemic complications than other protection systems. To reduce cerebral ischemic complications, CAS was performed under combined cerebral protection using both flow reversal (FR) and a distal filter.
Fifty-six stenoses of 52 patients were treated with CAS using the combined protection of FR and a distal filter, with intermittent occlusion of both the common carotid artery (CCA) and the external carotid artery. The blood flow was reversed into the guiding catheter to the central venous system via an external filter, which collected the debris. Clinical outcomes, the rates of capturing visible debris, and new ischemic signals on diffusion-weighted magnetic resonance imaging (DWI-MRI) were evaluated.
The overall technical success rate was 92.9% (52/56). Successful stent deployment was achieved in 100% (56/56) of the cases. No procedural-related emboli causing a neurologic deficit were observed. In 38.5% (20/52) of the cases, visible debris were captured by only the external filter, and in 17.3% (9/52), visible debris were captured by both external and distal filters. In no case was visible debris noted in only the distal filter. New ischemic signals on DWI-MRI were detected in 9.6% (5/52). The 30-day myocardial infarction, stroke, and death rates were 0%.
The additional use of a distal filter captures emboli in 17.3% of cases, and because the occlusion is only intermittent, the procedure is potentially applicable even in those who cannot tolerate prolonged balloon occlusion of the CCA.
采用远端滤器保护的颈动脉支架置入术（CAS）可实现持续脑灌注，尽管与其他保护系统相比，其发生脑缺血并发症的风险更高。为减少脑缺血并发症，在血流逆转（FR）和远端滤器联合脑保护下进行CAS。
对52例患者的56处狭窄病变采用FR和远端滤器联合保护进行CAS治疗，同时间歇性阻断颈总动脉（CCA）和颈外动脉。血流通过外部滤器逆向流入引导导管至中心静脉系统，该滤器可收集碎片。评估临床结局、捕获可见碎片的比率以及扩散加权磁共振成像（DWI-MRI）上的新缺血信号。
总体技术成功率为92.9%（52/56）。100%（56/56）的病例成功置入支架。未观察到导致神经功能缺损的与手术相关的栓子。在38.5%（20/52）的病例中，仅外部滤器捕获到可见碎片，17.3%（9/52）的病例中，外部和远端滤器均捕获到可见碎片。仅远端滤器未捕获到可见碎片的情况。DWI-MRI上检测到新缺血信号的比例为9.6%（5/52）。30天内心肌梗死、卒中及死亡率均为0%。
额外使用远端滤器在17.3%的病例中捕获到栓子，并且由于仅为间歇性阻断，该手术甚至可能适用于不能耐受CCA长时间球囊阻断的患者。
