Dargazanli Cyril, Mahmoudi Mehdi, Cappucci Matteo, Collemiche François-Louis, Labreuche Julien, Habza Othmane, Gascou Grégory, Lefèvre Pierre-Henri, Eker Omer, Mourand Isabelle, Gaillard Nicolas, Charif Mahmoud, Derraz Imad, Arquizan Caroline, Costalat Vincent
Neuroradiology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, 81 avenue Augustin Fliche, 34295, Montpellier, France.
Laboratory of Cerebrovascular Mechanisms of Brain Disorders, Department of Neuroscience, Institute of Functional Genomics, UMR 5203 CNRS - U 1191 INSERM, University of Montpellier, Montpellier, France.
Clin Neuroradiol. 2020 Jun;30(2):363-372. doi: 10.1007/s00062-019-00770-8. Epub 2019 Mar 7.
The best embolic protection strategy has not yet been established for carotid artery stenting (CAS). This article reports a new simplified approach using a balloon guide catheter inspired by stroke therapy, in patients harboring a symptomatic ICA atherosclerotic stenosis or web. In addition, the three angiographic patterns and clinical outcomes associated with this technique, called the simple flow blockage (SFB) technique are described.
This was a retrospective study with data extraction from a monocentric prospective clinical registry of consecutive patients admitted for symptomatic ICA stenosis or web. The primary study outcome (composite endpoint) was the rate of occurrence of death, symptomatic stroke or acute coronary syndrome within 30 days of the intervention.
In this study 75 symptomatic patients with >50% carotid artery atherosclerotic stenosis or web were included. All procedures were successfully performed. The composite endpoint occurred in 3 patients (4.0%, 95% confidence interval, CI, 0.0-11.3): 1 had symptomatic ischemic stroke, 1 had reperfusion syndrome with symptomatic intracranial hemorrhage and 1 had acute coronary syndrome. After proximal balloon inflation three angiographic patterns were observed: complete contrast column stagnation in the ICA (38.7%), retrograde washout of the ICA from the intracranial circulation towards the external carotid artery (35.5%) and antegrade washout of contrast medium towards the intracranial circulation (25.8%). The median procedure length was 40 min. New asymptomatic ischemic lesions were observed in 22.5% on DWI-MRI.
The SFB technique enables fast and safe procedures in CAS. A favorable angiographic pattern after proximal balloon inflation was observed in 74.2% of cases.
颈动脉支架置入术（CAS）的最佳栓塞保护策略尚未确立。本文报道了一种受卒中治疗启发的、使用球囊引导导管的新简化方法，用于治疗有症状的颈内动脉（ICA）粥样硬化狭窄或膜状蹼患者。此外，还描述了与这种称为简单血流阻断（SFB）技术相关的三种血管造影模式及临床结果。
这是一项回顾性研究，数据取自一个单中心前瞻性临床登记库，该登记库纳入了因有症状的ICA狭窄或膜状蹼而连续入院的患者。主要研究结局（复合终点）是干预后30天内死亡、有症状性卒中或急性冠状动脉综合征的发生率。
本研究纳入了75例有症状的、颈动脉粥样硬化狭窄或膜状蹼超过50%的患者。所有手术均成功完成。复合终点事件发生在3例患者中（4.0%，95%置信区间，CI，0.0 - 11.3）：1例发生有症状性缺血性卒中，1例发生伴有症状性颅内出血的再灌注综合征，1例发生急性冠状动脉综合征。近端球囊充盈后观察到三种血管造影模式：ICA内造影剂柱完全停滞（38.7%）、ICA从颅内循环向颈外动脉逆行冲洗（35.5%）以及造影剂向颅内循环顺行冲洗（25.8%）。手术中位时长为40分钟。在DWI - MRI上，22.5%的患者观察到新的无症状性缺血性病变。
SFB技术可使CAS手术快速且安全。近端球囊充盈后，74.2%的病例观察到良好的血管造影模式。
