Enomoto Yukiko, Egashira Yusuke, Funatsu Naoko, Yamauchi Keita, Matsubara Hirofumi, Iwama Toru
Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan.
Department of Rehabilitation Therapy, Gifu Seiryu Hospital, Gifu, Gifu, Japan.
J Neuroendovasc Ther. 2022;16(5):237-242. doi: 10.5797/jnet.oa.2021-0066. Epub 2021 Sep 16.
The association between stent design and post-stent intravascular findings after carotid artery stenting (CAS) was evaluated.
Among the 79 patients who underwent CAS between March 2016 and June 2020 at our institution, we retrospectively analyzed 65 patients with full post-stent intravascular evaluation by both optical frequency domain imaging and angioscopy. All CAS procedures were performed under the flow reversal method, and the stent selection was determined by each operator's discretion, depending on the vessel anatomy or plaque characteristics. The patient's characteristics, plaque characteristics, ischemic complication, and post-stent intravascular findings (plaque protrusion, vessel wall apposition of stent) were compared between the closed-cell and open-cell stent groups.
The closed-cell group (n = 34) had more high-risk plaques, such as symptomatic lesions or intraplaque hemorrhages, on MRI compared with the open-cell group (n = 31). There was no difference in the rate of ischemic complications between the groups. Although there was no difference in the frequency of plaque protrusion between the two, the maximum height of the protruded plaque was higher in the open-cell group (320 vs. 612 μm, p = 0.003) and incomplete apposition was higher in the closed-cell group (85.3 vs. 6.5%, p <0.0001).
The open-cell stent provided better apposition but had larger plaque protrusion. The need for a new hybrid stent that combines the merits of both open- and closed-cell stents was suggested.
评估颈动脉支架置入术（CAS）后支架设计与支架置入后血管内表现之间的关联。
在2016年3月至2020年6月期间于我院接受CAS的79例患者中，我们回顾性分析了65例通过光学频域成像和血管内镜进行了完整的支架置入后血管内评估的患者。所有CAS手术均采用血流逆转法进行，支架的选择由每位操作者根据血管解剖结构或斑块特征自行决定。比较了闭合型支架组和开放型支架组患者的特征、斑块特征、缺血性并发症以及支架置入后血管内表现（斑块突出、支架与血管壁贴合情况）。
与开放型支架组（n = 31）相比，闭合型支架组（n = 34）在MRI上有更多高危斑块，如症状性病变或斑块内出血。两组间缺血性并发症发生率无差异。虽然两组间斑块突出的频率无差异，但开放型支架组突出斑块的最大高度更高（320 vs. 612μm，p = 0.003），而闭合型支架组不完全贴合的情况更多（85.3% vs. 6.5%，p <0.0001）。
开放型支架提供了更好的贴合，但斑块突出更大。提示需要一种结合开放型和闭合型支架优点的新型混合支架。
