Kim Bo Kyu, Kim Byungjun, You Sung-Hye, Ryoo Inseon, Jung Hye Na
Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
Department of Radiology, Korea University Guro Hospital, Seoul 08308, Republic of Korea.
Diagnostics (Basel). 2024 Nov 21;14(23):2622. doi: 10.3390/diagnostics14232622.
This study aimed to evaluate the incidence, risk factors, clinical implications, and rescue maneuvers of technical complications related to embolic protection devices (EPDs) during carotid artery stenting (CAS). We retrospectively reviewed all patients who had undergone CAS with EPDs between April 2018 and March 2024. The incidence and types of technical complication associated with EPDs were assessed. Clinical, angiographical, and procedural factors were analyzed to identify risk factors for the occurrence of EPD-related adverse events. Various rescue techniques for managing adverse events were investigated based on the procedure record. Of the 158 enrolled patients, the rate of EPD-related technical complications was 23.4% ( = 37). Among them, complicated filter retrieval was the most common adverse event ( = 23, 14.6%). Older age, a higher degree of residual stenosis, and the type of the EPD were significant risk factors for complicated filter retrieval ( < 0.05). Although distal thrombus migration requiring thrombectomy was more frequent in patients with complicated filter removal (2.2% vs. 13.0%, = 0.041), there was no significant increase in postprocedural thromboembolic and hemorrhagic complications. When complicated filter retrieval occurred, careful to-and-fro movement of the patients' neck, such as rotation, or asking them to swallow was tried first in all 23 patients. When these attempts failed, manipulation of a curved-tip guiding catheter, the balloon bridge technique, and alternative use of a 5 Fr angiocatheter as a retrieval sheath were sequentially tried, and all filters were successfully retrieved. Complicated filter retrieval was the most common technical complication during CAS. Various rescue techniques for successful filter removal were effective for ensuring safety of CAS.
本研究旨在评估颈动脉支架置入术（CAS）期间与栓子保护装置（EPD）相关的技术并发症的发生率、危险因素、临床意义及补救措施。我们回顾性分析了2018年4月至2024年3月期间所有接受带EPD的CAS的患者。评估了与EPD相关的技术并发症的发生率和类型。分析临床、血管造影和手术因素，以确定EPD相关不良事件发生的危险因素。根据手术记录研究了处理不良事件的各种补救技术。在158例纳入患者中，EPD相关技术并发症的发生率为23.4%（n = 37）。其中，复杂滤器取出是最常见的不良事件（n = 23，14.6%）。年龄较大、残余狭窄程度较高和EPD类型是复杂滤器取出的显著危险因素（P < 0.05）。尽管在复杂滤器取出的患者中需要进行血栓切除术的远端血栓迁移更为频繁（2.2%对13.0%，P = 0.041），但术后血栓栓塞和出血并发症并无显著增加。当发生复杂滤器取出时，在所有23例患者中首先尝试让患者颈部进行仔细的来回移动，如旋转，或让他们吞咽。当这些尝试失败时，依次尝试使用弯头引导导管操作、球囊桥接技术以及交替使用5 Fr血管造影导管作为取出鞘，所有滤器均成功取出。复杂滤器取出是CAS期间最常见的技术并发症。各种成功取出滤器的补救技术对于确保CAS的安全性是有效的。
