Very Low Rate of New Brain Lesions After Vulnerable Carotid Artery Stenting Cases Using Only FilterWire EZ as Distal Embolic Protection
| Autor: | Atsushi Ishida, Keizoh Asakuno, Hideki Shiramizu, Ko Nakase, Seigo Matsuo, Haruko Yoshimoto, Masataka Kato |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Target lesion medicine.medical_specialty medicine.medical_treatment Carotid arteries Embolism Carotid endarterectomy medicine.disease_cause Embolic Protection Devices 03 medical and health sciences 0302 clinical medicine medicine Humans Carotid Stenosis Aged Retrospective Studies Embolic protection Endarterectomy Carotid medicine.diagnostic_test business.industry Medical record Brain Magnetic resonance imaging Middle Aged medicine.disease Vulnerable plaque Plaque Atherosclerotic Surgery Stenosis Brain Injuries 030220 oncology & carcinogenesis Female Stents Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 141:e145-e150 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2020.05.028 |
| Popis: | Background Although carotid artery stenting (CAS) has been widely acknowledged as an effective alternative option for patients at high risk of carotid endarterectomy, embolic stroke is a major complication of CAS. Several reports have emphasized that distal protection filter alone is associated with a high risk of embolic complications of CAS with vulnerable plaque. Thus, relatively complicated protection systems have recently been recommended to prevent distal embolic complications. However, those protection systems require many steps, which, themselves, can also cause complications. The FilterWire EZ embolic protection device (EPD) for use in CAS was approved for national health insurance coverage in Japan in 2010. Since then, we have been using it as an EPD in all CAS procedures, even those with vulnerable plaque. Methods The medical records of 80 patients who had undergone CAS from February 2014 to September 2019 at Moriyama Memorial Hospital were retrospectively reviewed. Emergent cases with distal mechanical thrombectomy were not included. We enrolled patients whose target lesion was vulnerable as evaluated by magnetic resonance imaging and who had undergone diffusion-weighted imaging studies the next day. Results Of the 80 patients, 60 had met the inclusion criteria. No symptomatic embolic complications developed, and only 5 patients (8.3%) had shown new lesions on diffusion-weighted imaging after CAS. The rate of new lesions after CAS with vulnerable plaque was much lower than that in previous studies. We meticulously analyzed the data to determine the predictive factors. Conclusion The FilterWire EZ as an EPD for CAS is quite safe, even for vulnerable carotid stenosis. |
| Databáze: | OpenAIRE |
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