Arai Shintaro, Ikeda Hisato, Kawamo Michiari, Kamiya Yuki, Mizutani Tohru
Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan; Department of Neurosurgery, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
Department of Neurosurgery, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
World Neurosurg. 2019 Feb;122:215-219. doi: 10.1016/j.wneu.2018.10.214. Epub 2018 Nov 9.
Despite the development of neuroendovascular treatment, device-related complications requiring surgical procedures remain. We report a case requiring surgical retrieval of a filter protection device in carotid artery stenting (CAS) with an open-cell stent, due to stent deformation, and review past reports on CAS in which surgical retrieval of devices was required.
An 82-year-old man underwent CAS for symptomatic right internal carotid artery stenosis with severe calcification and tortuosity. Immediately after placement of the open-cell stent, stent deformation was detected and the filter protection device could not be retrieved. All noninvasive device retrieval attempts failed, and the device was ultimately retrieved surgically. After surgery, right cerebral infarction progressed increased, but no permanent deficit was observed.
As the treatment of cerebrovascular disease shifts from surgical to endovascular approaches, surgeons must be familiar with devices and techniques to manage complications of neuroendovascular treatment.
尽管神经血管内治疗有所发展,但仍存在需要外科手术处理的与器械相关的并发症。我们报告一例因支架变形需要通过外科手术取出颈动脉支架置入术(CAS)中使用的开孔型支架的滤器保护装置的病例,并回顾以往需要外科手术取出器械的CAS相关报道。
一名82岁男性因有症状的右侧颈内动脉严重钙化和迂曲狭窄接受了CAS治疗。在置入开孔型支架后立即检测到支架变形,滤器保护装置无法取出。所有非侵入性取出器械的尝试均失败,最终通过外科手术取出了该装置。术后,右侧脑梗死进展加重,但未观察到永久性神经功能缺损。
随着脑血管疾病的治疗从外科手术转向血管内治疗方法,外科医生必须熟悉处理神经血管内治疗并发症的器械和技术。