Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
J Neurointerv Surg. 2019 Jan;11(1):62-67. doi: 10.1136/neurintsurg-2018-013869. Epub 2018 Jun 21.
Despite various measures to protect against distal embolization during carotid artery stenting (CAS), periprocedural ischemic lesions are still encountered.
To evaluate the periprocedural cerebral diffusion weighted imaging (DWI) lesion burden after CASPER stent placement.
Patients who underwent CAS using the CASPER stent system were reviewed. Degrees of carotid stenosis and plaque configuration were determined. All patients were pretreated with dual antiplatelet agents and cerebral pre- and postprocedural MRI was obtained. All CAS procedures were performed by a single operator.
A total of 110 patients with severe carotid artery stenosis (median degree of stenosis 80%, median length of stenosis 10 mm) were treated with CAS. Hypoechogenic or heterogeneous, mostly hypoechogenic, plaques were documented in 48.6% (52/107) of patients. Carotid ulceration was present in 15.9% (17/107). Postprocedurally, 7.3% (8/110) of patients were found to have ischemic DWI lesions. They were asymptomatic in all patients. Follow-up at 90 days was available in 88.2% (97/110) of patients with excellent functional outcome (modified Rankin Scale score 0-1) in 95.9% (93/97).
Carotid artery stenting using the new CASPER stent in combination with a distal embolic protection device is safe and results in a lower rate of periprocedural DWI lesion burden compared with reported results for historic controls.
尽管采取了各种措施来防止颈动脉支架置入术（CAS）期间的远端栓塞，但仍会发生围手术期缺血性病变。
评估 CASPER 支架置入后经颅扩散加权成像（DWI）病变负担。
回顾性分析使用 CASPER 支架系统行 CAS 的患者。确定颈动脉狭窄程度和斑块形态。所有患者均接受双联抗血小板治疗，并在术前和术后进行脑 MRI。所有 CAS 手术均由一名术者完成。
共 110 例严重颈动脉狭窄患者（狭窄程度中位数为 80%，狭窄长度中位数为 10mm）接受了 CAS 治疗。48.6%（52/107）的患者存在低回声或不均匀、多为低回声的斑块。15.9%（17/107）的患者存在颈动脉溃疡。术后 7.3%（8/110）的患者出现缺血性 DWI 病变。所有患者均无症状。110 例患者中 88.2%（97/110）进行了 90 天随访，95.9%（93/97）的患者的功能预后良好（改良 Rankin 量表评分 0-1）。
与历史对照结果相比，新型 CASPER 支架联合远端保护装置的颈动脉支架置入术是安全的，且与术中 DWI 病变负担发生率较低相关。
