Wada Takeshi, Takayama Katsutoshi, Myouchin Kaoru, Oshima Keisuke, Tanaka Toshihiro, Kichikawa Kimihiko
Department of Interventional Neuroradiology/Radiology, Kouseikai Takai Hospital, Tenri, Nara, Japan.
Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
J Neuroendovasc Ther. 2023;17(1):32-36. doi: 10.5797/jnet.cr.2022-0054. Epub 2022 Nov 30.
Plaque protrusion (PP) during carotid artery stenting (CAS) is considered to be associated with periprocedural ischemic stroke. A new double-layer micromesh stent, the CASPER stent (CS), was approved for use in Japan in 2020. The expectation is that this micromesh stent system will reduce the risk of PP, but we report a case of PP during CAS despite the use of a CS.
An 87-year-old man presented with left hemiparesis. MRI showed right brain infarction and angiography showed right internal carotid artery stenosis with thrombus. Follow-up angiography after medical treatment showed that thrombus disappeared. We therefore performed CAS for right internal carotid artery stenosis with unstable plaque. CAS was performed under local anesthesia with Mo.Ma Ultra and FilterWire EZ protection using a CS placed to sufficiently cover the stenotic region. Conservative post-dilatation was then performed. Intravascular ultrasonography (IVUS) after post-dilatation showed the presence of PP. A second CS was then added using the stent-in-stent technique. No postoperative neurological abnormalities were found and the patient was discharged without postoperative complications. No stroke or restenosis has been observed as of 16 months after CAS.
PP can occur even when CAS is performed using the CS for carotid artery stenosis with unstable plaque. The importance of checking for PP using IVUS is suggested.
颈动脉支架置入术（CAS）期间的斑块突出（PP）被认为与围手术期缺血性卒中有关。一种新型双层微网支架，即CASPER支架（CS），于2020年在日本获批使用。人们期望这种微网支架系统能降低PP的风险，但我们报告了1例尽管使用了CS但在CAS期间仍发生PP的病例。
一名87岁男性出现左侧偏瘫。磁共振成像（MRI）显示右脑梗死，血管造影显示右颈内动脉狭窄伴血栓形成。药物治疗后的随访血管造影显示血栓消失。因此，我们对伴有不稳定斑块的右颈内动脉狭窄进行了CAS。在局部麻醉下，使用Mo.Ma Ultra和FilterWire EZ保护装置，置入CS以充分覆盖狭窄区域，然后进行保守的后扩张。后扩张后的血管内超声（IVUS）显示存在PP。随后使用支架套入支架技术添加了第二个CS。术后未发现神经功能异常，患者出院时无术后并发症。截至CAS术后16个月，未观察到卒中或再狭窄。
即使在对伴有不稳定斑块的颈动脉狭窄进行CAS时使用CS，也可能发生PP。提示使用IVUS检查PP的重要性。
