Tokuyama Yoshiaki, Takada Tatsuro, Usuki Noriko, Takaishi Satoshi, Tatsuno Kentaro, Hamada Yuki, Otubo Haruki, Ueda Toshihiro
Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan.
J Neuroendovasc Ther. 2020;14(11):475-480. doi: 10.5797/jnet.oa.2019-0109. Epub 2020 Aug 18.
Embolic stroke is the most serious complication after carotid artery stenting (CAS). The incidence rate of embolic stroke is reduced by the use of embolic protection devices (EPDs); however, there is no consensus on which EPD is the most effective. The aspiration and re-transfusion technique (ART) with CAS under distal balloon protection was adopted at our center to reduce the incidence of embolic complications. This retrospective study investigated the effects of ART.
From November 2010, 243 consecutive patients treated by CAS under distal balloon protection were included. ART was performed on 202 patients (ART group) and the other 40 patients only received distal balloon protection (non-ART group). In ART, the blood from the aspiration catheter was continuously returned through a filter to the femoral vein. The amount of debris was assessed intermittently using a small blood sample and the rest was returned. We investigated the diffusion-weighted imaging (DWI)-positive rate and symptomatic ischemic stroke one day after CAS.
Compared with the non-ART group, the incidence of DWI-positive lesions (22.7% vs 37.5%, P = 0.07) and frequency of symptomatic ischemic stroke (0.9% vs 5.0%, P = 0.12) were reduced in the ART group. The hemoglobin reduction rate was significantly reduced by ART (11.1% vs 14.9%, P <0.01). In the ART group, the frequency of multiple lesions (more than 5) and large lesions (more than 10 mm) was lower than that in the non-ART group (P <0.01, P = 0.14).
CAS under distal balloon protection with ART was effective at reducing the incidence of DWI-positive lesions and may be useful to reduce the incidence of symptomatic ischemic stroke.
栓塞性卒中是颈动脉支架置入术（CAS）后最严重的并发症。使用栓塞保护装置（EPD）可降低栓塞性卒中的发生率；然而，对于哪种EPD最有效尚无共识。我们中心采用在远端球囊保护下的CAS联合抽吸再灌注技术（ART）来降低栓塞并发症的发生率。这项回顾性研究调查了ART的效果。
从2010年11月起，纳入243例在远端球囊保护下接受CAS治疗的连续患者。202例患者接受了ART（ART组），另外40例患者仅接受远端球囊保护（非ART组）。在ART中，抽吸导管抽出的血液通过过滤器持续回输至股静脉。使用少量血样间歇性评估碎片量，其余血液回输。我们调查了CAS术后一天的扩散加权成像（DWI）阳性率和症状性缺血性卒中情况。
与非ART组相比，ART组DWI阳性病变的发生率（22.7%对37.5%，P = 0.07）和症状性缺血性卒中的发生率（0.9%对5.0%，P = 0.12）有所降低。ART显著降低了血红蛋白降低率（11.1%对14.9%，P <0.01）。在ART组中，多个病变（超过5个）和大病变（超过10 mm）的发生率低于非ART组（P <0.01，P = 0.14）。
在远端球囊保护下联合ART的CAS在降低DWI阳性病变发生率方面有效，可能有助于降低症状性缺血性卒中的发生率。
