Ichikawa Tomonori, Yasuda Ryuta, Yamamoto Atsushi, Nishikawa Hirofumi, Fujimoto Masashi, Miura Yoichi, Toma Naoki, Suzuki Hidenori
Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
J Neuroendovasc Ther. 2022;16(11):570-575. doi: 10.5797/jnet.cr.2022-0028. Epub 2022 Oct 21.
We describe 3 cases with folding deformation of a PRECISE (Cordis, Miami, FL, USA) stent in carotid artery stenting (CAS).
The 3 cases with cervical carotid stenosis consisted of 3 males around 80 years old and included 2 symptomatic lesions. During CAS, distal embolic protection was established using a Mo.Ma (Medtronic, Minneapolis, MN, USA) along with a filter device in 2 cases and an Optimo (Tokai Medical Products, Aichi, Japan) along with a filter device in 1 case. For the filter device, either FilterWire EZ (Boston Scientific, Natick, MA, USA) or Spider FX (Covidien, Irvine, CA, USA) was employed. In all cases, a PRECISE stent was deployed after pre-dilation performed using a percutaneous transluminal angioplasty (PTA) balloon with the diameter of 2.5 to 3 mm. Post-dilation was performed after the stent deployment using a PTA balloon whose diameter was about 80% of that of the normal distal internal carotid artery. In all cases, cone-beam CT taken after the deployment of a stent showed folding deformation of the stent. In 2 cases, heavily calcified plaque hampered self-expansion of the stent, which resulted in the stent deformation. On the other hand, in the remaining 1 case, a distal shaft of the Mo.Ma caused the stent deformation, which was likely accelerated by head rotation and cervical compression that was performed to resolve difficulties for a filter retrieval device to pass through the stent, and post-dilation after the stenting.
Heavily calcified plaque and a distal shaft of a Mo.Ma would result in stent deformation.
我们描述了3例在颈动脉支架置入术（CAS）中PRECISE（美国佛罗里达州迈阿密市科迪斯公司）支架发生折叠变形的病例。
3例颈段颈动脉狭窄患者均为80岁左右的男性，其中2例有症状性病变。在CAS过程中，2例使用Mo.Ma（美国明尼阿波利斯市美敦力公司）联合滤器装置建立远端栓塞保护，1例使用Optimo（日本爱知县东海医疗产品公司）联合滤器装置。对于滤器装置，使用了FilterWire EZ（美国马萨诸塞州纳蒂克市波士顿科学公司）或Spider FX（美国加利福尼亚州欧文市柯惠医疗公司）。在所有病例中，使用直径为2.5至3 mm的经皮腔内血管成形术（PTA）球囊进行预扩张后，植入PRECISE支架。支架植入后，使用直径约为正常颈内动脉远端直径80%的PTA球囊进行后扩张。在所有病例中，支架植入后进行的锥形束CT显示支架发生折叠变形。2例中，严重钙化的斑块阻碍了支架的自膨胀，导致支架变形。另一方面，在其余1例中，Mo.Ma的远端杆部导致了支架变形，这可能因头部旋转和颈部压迫而加速，头部旋转和颈部压迫是为了解决滤器回收装置通过支架的困难以及支架置入后的后扩张。
严重钙化的斑块和Mo.Ma的远端杆部会导致支架变形。
