Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
World Neurosurg. 2020 Sep;141:e145-e150. doi: 10.1016/j.wneu.2020.05.028. Epub 2020 May 11.
Although carotid artery stenting (CAS) has been widely acknowledged as an effective alternative option for patients at high risk of carotid endarterectomy, embolic stroke is a major complication of CAS. Several reports have emphasized that distal protection filter alone is associated with a high risk of embolic complications of CAS with vulnerable plaque. Thus, relatively complicated protection systems have recently been recommended to prevent distal embolic complications. However, those protection systems require many steps, which, themselves, can also cause complications. The FilterWire EZ embolic protection device (EPD) for use in CAS was approved for national health insurance coverage in Japan in 2010. Since then, we have been using it as an EPD in all CAS procedures, even those with vulnerable plaque.
The medical records of 80 patients who had undergone CAS from February 2014 to September 2019 at Moriyama Memorial Hospital were retrospectively reviewed. Emergent cases with distal mechanical thrombectomy were not included. We enrolled patients whose target lesion was vulnerable as evaluated by magnetic resonance imaging and who had undergone diffusion-weighted imaging studies the next day.
Of the 80 patients, 60 had met the inclusion criteria. No symptomatic embolic complications developed, and only 5 patients (8.3%) had shown new lesions on diffusion-weighted imaging after CAS. The rate of new lesions after CAS with vulnerable plaque was much lower than that in previous studies. We meticulously analyzed the data to determine the predictive factors.
The FilterWire EZ as an EPD for CAS is quite safe, even for vulnerable carotid stenosis.
尽管颈动脉支架置入术（CAS）已被广泛认为是高危颈动脉内膜切除术患者的有效替代选择，但栓塞性中风是 CAS 的主要并发症。有几项报告强调，单纯使用远端保护滤器与易损斑块的 CAS 栓塞性并发症风险较高相关。因此，最近推荐使用相对复杂的保护系统来预防远端栓塞性并发症。然而，这些保护系统需要许多步骤，而这些步骤本身也可能导致并发症。FilterWireEZ 栓塞保护装置（EPD）于 2010 年在日本获得国家健康保险覆盖的批准。从那时起，我们一直在所有 CAS 手术中使用它作为 EPD，即使是易损斑块的病例。
回顾性分析了 2014 年 2 月至 2019 年 9 月在森山纪念医院接受 CAS 的 80 例患者的病历。不包括远端机械血栓切除术的紧急病例。我们纳入了经磁共振成像评估为靶病变易损且次日进行弥散加权成像研究的患者。
80 例患者中，60 例符合纳入标准。没有出现症状性栓塞性并发症，只有 5 例（8.3%）在 CAS 后出现新的弥散加权成像病变。CAS 伴易损斑块的新病变发生率明显低于以往研究。我们仔细分析了数据，以确定预测因素。
FilterWireEZ 作为 CAS 的 EPD 非常安全，即使是易损颈动脉狭窄。
