Spiliopoulos Stavros, Theodosiadou Vasiliki, Koukounas Vasilios, Katsanos Konstantinos, Diamantopoulos Athanasios, Kitrou Panagiotis, Ravazoula Panagiota, Siablis Dimitris, Karnabatidis Dimitris
1 Department of Interventional Radiology, Patras University Hospital, School of Medicine, University of Patras, Greece.
J Endovasc Ther. 2014 Aug;21(4):474-81. doi: 10.1583/14-4703.1.
To investigate the phenomenon of distal embolization during subintimal angioplasty with or without stenting of femoropopliteal chronic total occlusions (CTOs).
This prospective study included 40 consecutive patients (35 men; mean age 65.4±9.3 years) who underwent subintimal angioplasty alone (n=14) or with stenting (n=26) of CTOs in the femoropopliteal segment. A Spider protection filter was used to capture any possible macro- or microemboli generated during balloon inflation/stenting. Arterial outflow was angiographically checked during each consecutive procedural step. All filters were examined on site for macroscopic material, while the first 20 filters underwent further histopathological qualitative and semiquantitative analysis using a 0+ to 3+ score.
There was no angiographically or clinically evident distal embolization. Macroscopic particulate debris was not detected in any filter. Histopathology confirmed the absence of macroemboli but revealed microembolic material (diameter <100 μm) in all filters (20/20). The mean number of particles detected was 9.4±4.5 (range 5-17). Histopathological findings included fibrin conglomerates (20/20), trapped erythrocytes (19/20), inflammatory cells (16/20), calcification minerals (6/20), extracellular matrix (6/20), cholesterol clefts (6/20), and endothelial cells (6/20). Captured material was classified as fresh and old thrombus in 7/20 and 4/20 cases, respectively. Semiquantitative analysis demonstrated that the collected microparticles consisted primarily of fibrin conglomerates (median score 2+), trapped erythrocytes (median score 1+), and inflammatory cells (median score 1+).
Macroscopically evident emboli were not detected following subintimal angioplasty or stenting of femoropopliteal CTOs. Microscopic debris was present in all filters. The clinical significance of the phenomenon remains to be determined.
研究股腘动脉慢性完全闭塞（CTO）行或不行支架置入的内膜下血管成形术期间远端栓塞现象。
这项前瞻性研究纳入了40例连续患者（35例男性；平均年龄65.4±9.3岁），他们接受了股腘段CTO单纯内膜下血管成形术（n = 14）或联合支架置入术（n = 26）。使用Spider保护滤器捕获球囊扩张/支架置入期间产生的任何可能的大或微栓子。在每个连续的手术步骤中通过血管造影检查动脉流出情况。所有滤器均在现场检查有无宏观物质，而前20个滤器使用0 +至3 +评分进行进一步的组织病理学定性和半定量分析。
未发现血管造影或临床上明显的远端栓塞。在任何滤器中均未检测到宏观颗粒碎片。组织病理学证实无大栓子，但在所有滤器（20/20）中均发现了微栓子物质（直径<100μm）。检测到的颗粒平均数为9.4±4.5（范围5 - 17）。组织病理学发现包括纤维蛋白聚集体（20/20）、捕获的红细胞（19/20）、炎性细胞（16/20）、钙化矿物质（6/20）、细胞外基质（6/20）、胆固醇裂隙（6/20）和内皮细胞（6/20）。捕获的物质在7/20和4/20的病例中分别被分类为新鲜血栓和陈旧血栓。半定量分析表明，收集的微粒主要由纤维蛋白聚集体（中位数评分2 +）、捕获的红细胞（中位数评分1 +）和炎性细胞（中位数评分1 +）组成。
股腘动脉CTO内膜下血管成形术或支架置入术后未检测到宏观明显的栓子。所有滤器中均存在微观碎片。该现象的临床意义仍有待确定。
