Myouchin Kaoru, Takayama Katsutoshi, Wada Takeshi, Chanoki Yuto, Kishida Hayato, Masutani Takahiro, Ko Yumi, Uchiyama Yoshitomo, Nakagawa Ichiro, Tanaka Toshihiro
Department of Interventional Neuroradiology/Radiology, Kouseikai Takai Hospital, Tenri, Japan.
Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan.
J Soc Cardiovasc Angiogr Interv. 2024 Oct 29;3(11):102285. doi: 10.1016/j.jscai.2024.102285. eCollection 2024 Nov.
Intravascular ultrasound-determined plaque protrusion (PP) during carotid artery stenting (CAS) using conventional stents is reported in 7.6% to 12% of cases and is associated with periprocedural cerebral embolism. The Casper/Roadsaver stent (CRS) is a dual-layer micromesh stent designed to reduce the risk of PP, with a mesh cell diameter 4-fold smaller size than that of conventional stents. This study investigated the incidence of PP with CRS CAS.
We prospectively analyzed 89 consecutive arteriosclerotic carotid artery stenoses in 82 patients (64 men; mean age, 76.8 years; 43 symptomatic) who underwent CAS with CRS under intravascular ultrasound. The main end points were the technical success rate, incidences of intraprocedural PP and at 1 week after CAS (delayed PP), incidence of new ipsilateral diffusion-weighted imaging lesion within 48 hours post CAS, and major adverse events (myocardial infarction, stroke, death) within 30 days. Secondary end points were the rate of in-stent restenosis and ipsilateral stroke at 30 days and 12 months.
The technical success rate was 100%. Intraprocedural PP occurred in 2 patients (2.2%). Delayed PP occurred in 3 additional patients (3.4%). Diffusion-weighted imaging positivity was 24.7%. Major adverse events (minor stroke) occurred in 1 patient (1.1%). In-stent restenosis occurred in 5 patients (6.0%) by 12 months. No ipsilateral stroke occurred during the follow-up.
The incidence of intraprocedural PP with CRS CAS was 2.2%, indicating a significant reduction compared to conventional stents. However, at 7 days new PP had occurred in 3.4% of patients, indicating that patients with CRS should be followed up for delayed PP.
据报道，在使用传统支架进行颈动脉支架置入术（CAS）期间，血管内超声测定的斑块突出（PP）发生率为7.6%至12%，且与围手术期脑栓塞相关。Casper/Roadsaver支架（CRS）是一种双层微网支架，旨在降低PP风险，其网孔细胞直径比传统支架小4倍。本研究调查了CRS CAS中PP的发生率。
我们前瞻性分析了82例患者（64例男性；平均年龄76.8岁；43例有症状）的89例连续性动脉硬化性颈动脉狭窄患者，这些患者在血管内超声引导下接受了CRS CAS。主要终点为技术成功率、术中PP发生率以及CAS后1周（延迟性PP）的发生率、CAS后48小时内新的同侧弥散加权成像病变的发生率以及30天内的主要不良事件（心肌梗死、中风、死亡）。次要终点为30天和12个月时的支架内再狭窄率和同侧中风率。
技术成功率为100%。术中PP发生在2例患者（2.2%）。另外3例患者（3.4%）发生了延迟性PP。弥散加权成像阳性率为24.7%。主要不良事件（轻度中风）发生在1例患者（1.1%）。12个月时，5例患者（6.0%）发生了支架内再狭窄。随访期间未发生同侧中风。
CRS CAS术中PP的发生率为2.2%，与传统支架相比有显著降低。然而，7天时3.4%的患者出现了新的PP，这表明CRS患者应随访观察延迟性PP。
