Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting : Comparison of Several Anti-embolic Protection Devices
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概要
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Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusion-weighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm3 vs. 86.9 mm3, respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm3) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm3 and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.
- 2009-09-15
著者
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TAKI Waro
Departments of Neurosurgery, Kyoto University School of Medicine
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MAEDA Masayuki
Department of Radiology, Mie University School of Medicine
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MATSUSHIMA Satoshi
Department of Biochemistry, Faculty of Pharmaceutical Sciences, Okayama University
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Taki Waro
Department Of Neurosurgery Mie University School Of Medicine
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Taki Waro
Department Of Neurological Surgery Kitano Hospital
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Maeda Masayuki
Department Of Neuroradiology Mie University School Of Medicine
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Maeda Masayuki
Department Of Microbiology Showa University Of Pharmaceutical Sciences
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KAWAGUCHI Kenji
Department of Radiobiochemistry, School of Pharmaceutical Sciences, University of Shizuoka
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TAHA Mahmoud
Department of Neurosurgery, Kokura Memorial Hospital
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SAKAIDA Hiroshi
Department of Biochemistry, University of Texas Health Center at Tyler
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TOMA Naoki
Department of Physics, Osaka City University
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Sakaida Hiroshi
Department Of Neurosurgery Mie University School Of Medicine
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Sakaida Hiroshi
Department Of Biochemistry University Of Texas Health Center At Tyler
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YAMAMOTO Akitaka
Department of Neurosurgery, Mie University School of Medicine
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HIROSE Tomofumi
Department of Neurosurgery, Mie University School of Medicine
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MIURA Youichi
Department of Neurosurgery, Mie University School of Medicine
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FUJIMOTO Masashi
Department of Neurosurgery, Mie University School of Medicine
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Taha Mahmoud
Department Of Neurosurgery Kokura Memorial Hospital
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Taha Mahmoud
Department Of Neurosurgery Mie University School Of Medicine
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Toma Naoki
Department Of Neurosurgery Mie University School Of Medicine
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Miura Youichi
Department Of Neurosurgery Mie University School Of Medicine
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Miura Youichi
Department Of Cardiovascular Surgery Nagara Medical Center
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Hirose Tomofumi
Department Of Neurosurgery Mie University School Of Medicine
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Yamamoto Akitaka
Department Of Neurosurgery Mie University School Of Medicine
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Fujimoto Masashi
Department Of Neurosurgery Mie University School Of Medicine
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Fujimoto Masashi
Department Of Electronics Faculty Of Engineering Kyoto University
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Matsushima Satoshi
Department Of Neurosurgery Mie University School Of Medicine
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Matsushima Satoshi
Department Of Biochemistry Faculty Of Pharmaceutical Sciences Okayama University
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Maeda Masayuki
Department Of Agricultural Chemistry Faculty Of Agriculture Yamagata University
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Kawaguchi Kenji
Department Of Endovascular Neurosurgery Toranomon Hospital
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Kawaguchi Kenji
Department Of Neurosurgery Mie University School Of Medicine
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