頸部内頸動脈狭窄症に対するPTA/stentingを安全に行うための工夫

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Recently, PTA/stenting for cervical internal carotid artery (ICA) stenoses has been performed, especially in high-risk patients of carotid endarterectomy, despite unresolved problems, such as distal embolism. We report clinical results and complications of PTA/stenting for cervical internal carotid artery stenoses, and introduce our technique using blocking balloon catheter systems (BBCS) for safe and effective PTA/stenting. We treated 118 patients with cervical ICA stenosis by PTA or stenting. In 21 of 55 cases in which only PTA was done and in 48 of 63 cases in which stenting was performed, we used our BBCS to prevent distal embolism. Angiography, MRI and CT scan were utilized to detect infarcts due to distal embolism. In 20 lesions, diffusion-weighted MRI was performed to detect embolism in detail. The total morbidity and mortality rate was 5.1% and 0%, respectively. Morbidity at 30 days after treatment was 2.5%. Three patients had neurological deficits, 2 of whom had infarcts due to distal embolism and 1 of whom had intracerebral hematoma due to hyperperfusion. In patients of stenting with BBCS, morbidity at 30 days was 0%. In 15 lesions treated by stenting using BBCS at postdilatation, new hyperintense areas after PTA/stenting were detected in 7 lesions (47%) on diffusionweighted MRI, but only 1 patient had symptoms. To reduce distal embolism further, we now use BBCS and dilate the stenosis sufficiency at predilatation, and postdilatation is not added when a significant stenosis does not remain. For safe and effective PTA/stenting, (1) careful neuroradiological evaluation, (2) prudent placement of a large guiding catheter, (3) careful manipulation of microguidewire for advancement through the severe stenosis, (4) use of BBCS at predilatation as well as at postdilatation and (5) use of sufficient size of a PTA balloon at predilatation seemed to be neccessary. Our BBCS is a useful device to decrease the rate of symptomatic distal embolism in clinical results without increasing the total complication rate.
日本脳卒中の外科学会の論文
2002-05-31

頸部内頸動脈狭窄症に対するPTA/stentingを安全に行うための工夫

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