远端保护装置用于重度颈动脉狭窄的介入治疗

Application of cerebral protection filter in stenting of severe carotid stenosis

目的分析远端保护装置应用于颈动脉狭窄支架成形术的安全性和有效性。方法对26例症状性颈动脉狭窄患者行血管内支架成形术时应用远端保护装置,首先将远端保护装置通过狭窄部位并在狭窄远端展开,然后行保护性颈动脉支架成形术,观察围手术期缺血性脑卒中的发生情况,并观察保护装置滤网内捕获的斑块组织碎片。结果26例患者行远端滤网保护下的颈动脉支架成形术均获成功,回收的保护装置中有14个(54%)发现滤网中有斑块碎片组织和血栓颗粒,无死亡及急性栓塞事件发生,但有3例患者在手术后1～6d经磁共振检查发现了新的无症状性脑梗死病灶,26例患者在出院后临床随访期内未发生严重脑缺血事件。结论颈动脉支架成形术是重度症状性颈动脉狭窄的微创治疗方法,术中常规使用远端保护装置可提高颈动脉支架成形术的安全性和有效性。

Objective To analyze the effect and safety of cerebral protection filter in carotid artery and stenting （CAS） for the treatment of severe symptomatic carotid artery stenosis. Methods Elective CAS with the use of cerebral protection filters were undergone in 26 consecutive patients with severe carotid artery stenosis. The filter devices were advanced through lesions and opened distal to the lesions followed by CAS. The incidence of cerebral ischemic events and the debris collected in the filters were observed and analyzed. Results In all the patients, it was feasible and successful to position the filters devices in the internal carotid artery. After the filter devices were positioned, CAS were performed successfully in all the 26 patients. Thrombus or plague debris were found in 14 out of 26 retrieved filters （54%）. There was no death or symptomatic cerebral thromboembolic event during the CAS procedure. Asymptomatic cerebral embolization lesions were detected in 3 patients by the means of diffusion-weighted magnetic resonance imaging after 1 -6 days of the CAS. No major cerebral or cardiovascular ischemic events were recorded in all patients during their follow up period of 6 - 12 months. Conclusion Carotid artery stenting is an effective microinvasive therapy for severe carotid artery stenosis which effect and safety can be enhanced with the use of cerebral protection filter.