Sakamoto Shigeyuki, Kiura Yoshihiro, Okazaki Takahito, Shinagawa Katsuhiro, Ishii Daizo, Ichinose Nobuhiko, Kurisu Kaoru
Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
J Neurointerv Surg. 2016 Oct;8(10):1011-5. doi: 10.1136/neurintsurg-2015-012052. Epub 2015 Oct 9.
Carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis with vulnerable plaques is controversial. We analyzed the effect of a dual protection and blood aspiration method during CAS in patients with vulnerable plaques.
A total of 111 patients with ICA stenosis underwent CAS using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method. In 103 of 111 patients, preoperative carotid plaque was estimated by both 3 T MRI and ultrasonography (US). ICA plaques with a high intensity signal on time-of-flight-MR angiography (TOF-MRA) and/or mobile component on US were defined as vulnerable plaques. We assessed major adverse events (MAE) (ie, major stroke, myocardial infarction, and death) and hyperintense spots on diffusion-weighted images (DWI) after CAS. We then evaluated the visible debris captured by dual protection and blood aspiration during CAS.
The preoperative ICA plaque on TOF-MRA and US was judged to be vulnerable in 48.5% (50/103 patients). The success rate of the CAS procedure was 100% with no MAE within 30 days. DWI showed small hyperintense spots in 18% (9/50 patients) and 18.9% (10/53 patients) in the vulnerable and non-vulnerable plaque groups, respectively. Visible debris was captured in 68% (34/50 patients) and 45.3% (24/53 patients) in the vulnerable and non-vulnerable plaque groups, respectively (p=0.0286).
The combination of dual protection and blood aspiration could provide effective distal embolic protection although vulnerable plaques on TOF-MRA and US had a high incidence of debris during CAS. Thus, CAS using dual protection and blood aspiration is safe in patients with vulnerable plaques.
对于伴有易损斑块的颈内动脉（ICA）狭窄患者，颈动脉支架置入术（CAS）存在争议。我们分析了在伴有易损斑块的患者行CAS期间采用双重保护和血液抽吸方法的效果。
共有111例ICA狭窄患者采用双重保护（同时血流逆转和远端滤网）和血液抽吸方法行CAS。111例患者中的103例，术前通过3T磁共振成像（MRI）和超声检查（US）评估颈动脉斑块。飞行时间磁共振血管造影（TOF-MRA）上具有高强度信号和/或US上具有移动成分的ICA斑块被定义为易损斑块。我们评估了CAS术后的主要不良事件（MAE）（即重大卒中、心肌梗死和死亡）以及弥散加权成像（DWI）上的高信号斑点。然后我们评估了CAS期间通过双重保护和血液抽吸捕获的可见碎片。
TOF-MRA和US上的术前ICA斑块在48.5%（50/103例患者）中被判定为易损斑块。CAS手术成功率为100%，30天内无MAE。DWI显示，易损斑块组和非易损斑块组分别有18%（9/50例患者）和18.9%（10/53例患者）出现小的高信号斑点。易损斑块组和非易损斑块组分别有68%（34/50例患者）和45.3%（24/53例患者）捕获到可见碎片（p=0.0286）。
尽管TOF-MRA和US上的易损斑块在CAS期间碎片发生率较高，但双重保护和血液抽吸相结合可提供有效的远端栓塞保护。因此，对于伴有易损斑块的患者，采用双重保护和血液抽吸的CAS是安全的。
