Ohshima Tomotaka, Miyachi Shigeru, Matsuo Naoki, Kawaguchi Reo, Takayasu Masakazu
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, Yazakokarimata, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2019 Jul-Sep;14(3):1008-1010. doi: 10.4103/ajns.AJNS_296_18.
The combination of a flow reversal with two balloons and a filter protection device is one of the safest methods that can be used during carotid artery stenting (CAS). Although major adverse events did not occur under restrict protection, we experienced a case of in-filter thrombus during the procedure. A 68-year-old male presented with temporary right hemiparesis. The radiological examinations revealed 95% stenosis on the origin of the left internal carotid artery (ICA). The patient underwent left CAS of wherein a proximal common carotid artery balloon, an external carotid artery balloon, and a distal ICA filter, with continuous flow reversal to the femoral vein, were used. Although the reversal circulation was established, a massive newly developing thrombus was found in the proximal side of the filter. After an additional systemic heparinization, the thrombus disappeared. The procedure was performed without any complications. Physicians should be aware of the risk of developing intraprocedural thrombosis in a filter protection device. Because the filter protection device is designed for the antegrade flow, it may promote the development of thrombus against the retrograde flow. Thus, the filter protection device should be retrieved first under the flow reversal circumstance to avoid the distal migration of a clot around the filter device.
两个球囊与一个滤器保护装置相结合的血流逆转技术是颈动脉支架置入术（CAS）中最安全的方法之一。尽管在限制性保护下未发生重大不良事件，但我们在手术过程中遇到了一例滤器内血栓形成的病例。一名68岁男性出现短暂性右侧偏瘫。影像学检查显示左颈内动脉（ICA）起始处狭窄95%。患者接受了左颈动脉支架置入术，术中使用了近端颈总动脉球囊、颈外动脉球囊和远端颈内动脉滤器，并持续向股静脉进行血流逆转。尽管建立了逆转循环，但在滤器近端发现大量新形成的血栓。追加全身肝素化后，血栓消失。手术过程未出现任何并发症。医生应意识到滤器保护装置在手术过程中发生血栓形成的风险。由于滤器保护装置是为顺行血流设计的，它可能会促进血栓在逆流情况下的形成。因此，在血流逆转情况下应首先取出滤器保护装置，以避免滤器装置周围血栓的远端迁移。
