Department of Neuro-Vascular Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan.
J Neurointerv Surg. 2018 Mar;10(3):229-234. doi: 10.1136/neurintsurg-2017-013004. Epub 2017 Mar 30.
During carotid artery stenting (CAS) with the use of closed cell design stents for unstable plaques, tissue prolapse between stent struts was evaluated by optical coherence tomography (OCT).
14 carotid stenosis lesions diagnosed as unstable plaques by MRI were evaluated by OCT imaging during CAS using closed cell stents. Cross sectional OCT images within the stented segment were evaluated at 1 mm intervals. The slice rate for the presence of tissue prolapse between the struts was calculated.
No intra-procedural complications occurred. After single stent placement, plaque prolapse was observed in all cases. Slices with any and >500 µm tissue prolapse were seen in 30% and 7.8% of cases, respectively. In 5 of 7 lesions with tissue prolapse >500 µm, additional stents were overlapped. In cases with overlapping stents, slices with any tissue prolapse were significantly decreased from 26% to 16% (p=0.008); in particular, the occurrence of tissue prolapse >500 µm was significantly decreased from 15% to 2.3% (p<0.001). In one case of >500 µm tissue prolapse without an overlapping stent, delayed embolization due to an in-stent thrombus occurred 9 months after the procedure.
OCT during CAS using closed cell stent for unstable plaques frequently revealed tissue prolapse between struts. Placement of overlapping stents significantly reduced tissue prolapse, particularly tissue prolapse >500 µm. However, closed cell stents used for unstable plaques may not solve the problem of tissue prolapse.
在使用闭孔设计支架进行不稳定斑块颈动脉支架置入术（CAS）时，光学相干断层扫描（OCT）评估了支架梁之间的组织脱垂。
通过 OCT 成像评估 14 例经 MRI 诊断为不稳定斑块的颈动脉狭窄病变，在 CAS 中使用闭孔支架。以 1mm 的间隔评估支架段内的横截面 OCT 图像。计算支架梁之间存在组织脱垂的切片率。
无术中并发症发生。在单支架置入后，所有病例均观察到斑块脱垂。有和 >500μm 组织脱垂的切片分别占 30%和 7.8%。在 5 个组织脱垂>500μm 的病变中，重叠了额外的支架。在有重叠支架的病例中，任何组织脱垂的切片率从 26%显著下降至 16%（p=0.008）；特别是，>500μm 组织脱垂的发生率从 15%显著下降至 2.3%（p<0.001）。在一个无重叠支架的>500μm 组织脱垂病例中，由于支架内血栓形成，术后 9 个月发生迟发性栓塞。
在不稳定斑块的 CAS 中使用闭孔支架，OCT 经常显示支架梁之间的组织脱垂。重叠支架的放置显著减少了组织脱垂，特别是>500μm 的组织脱垂。然而，用于不稳定斑块的闭孔支架可能无法解决组织脱垂的问题。
