Distal filterおよびproximal balloonによるdouble protection techniqueを用いたCASの有用性
「はじめに」 頚動脈ステント留置術(carotid artery stenting: CAS)は, 頚動脈狭窄症に対する手術的治療の中で頚動脈内膜剥離術(carotid endarterectomy: CEA)に対する選択肢の1つとして進歩し, 良好な成績が報告されることが増えてきた. しかし, CASはCEAと比較して術後のMRI拡散強調像(DWI)陽性が多いことが以前より報告されており, CASにおいて最も重要なことは可能なかぎり周術期の塞栓性合併症を少なくすることである. 現在, 本邦ではdistal embolic protection deviceとしてdistal protecti...
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| Published in | 脳卒中の外科 Vol. 43; no. 1; pp. 26 - 31 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2015
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.43.26 |
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| Abstract | 「はじめに」 頚動脈ステント留置術(carotid artery stenting: CAS)は, 頚動脈狭窄症に対する手術的治療の中で頚動脈内膜剥離術(carotid endarterectomy: CEA)に対する選択肢の1つとして進歩し, 良好な成績が報告されることが増えてきた. しかし, CASはCEAと比較して術後のMRI拡散強調像(DWI)陽性が多いことが以前より報告されており, CASにおいて最も重要なことは可能なかぎり周術期の塞栓性合併症を少なくすることである. 現在, 本邦ではdistal embolic protection deviceとしてdistal protection balloon, filter device, またproximal protection deviceとしてballoon付きguiding catheterが使用され, soft plaqueやstring signを認めるhigh risk症例に対してもCASは積極的に施行されるようになった. |
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| AbstractList | 「はじめに」 頚動脈ステント留置術(carotid artery stenting: CAS)は, 頚動脈狭窄症に対する手術的治療の中で頚動脈内膜剥離術(carotid endarterectomy: CEA)に対する選択肢の1つとして進歩し, 良好な成績が報告されることが増えてきた. しかし, CASはCEAと比較して術後のMRI拡散強調像(DWI)陽性が多いことが以前より報告されており, CASにおいて最も重要なことは可能なかぎり周術期の塞栓性合併症を少なくすることである. 現在, 本邦ではdistal embolic protection deviceとしてdistal protection balloon, filter device, またproximal protection deviceとしてballoon付きguiding catheterが使用され, soft plaqueやstring signを認めるhigh risk症例に対してもCASは積極的に施行されるようになった. |
| Author | 吉田, 泰久 南, 浩昭 富永, 正吾 山浦, 生也 三木, 貴徳 松本, 洋明 宮地, 由樹 |
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| DOI | 10.2335/scs.43.26 |
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| References | 11) Stojanov D, Ilic M, Bosnjakovic P, et al : New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology. AJNR Am J Neuroradiol 33: 708-714, 2012 6) Gupta N, Corriere MA, Dodson TF, et al : The incidence of microemboli to the brain is less with endarterectomy than with percutaneous revascularization with distal filters or flow reversal. J Vasc Surg 53: 316-322, 2011 9) Montorsi P, Caputi L, Galli S, et al : Microembolization during carotid artery stenting in patients with high-risk, lipid rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58: 1656-1663, 2011 13) Yadav JS, Wholey MH, Kuntz RE, et al : Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351: 1493-1501, 2004 10) Schnaudigel S, Gröschel K, Pilgram SM, et al : New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39: 1911-1919, 2008 8) Milosevic ZV, Kocijancic IJ, Bunc M, et al : Dual cerebral protection technique during carotid stenting. J Endovasc Ther 14: 86-90, 2007 1) Bijuklic K, Wandler A, Hazizi F, et al : The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 59: 1383-1389, 2012 2) Bijuklic K, Wandler A, Varnakov Y, et al : Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv 6: 311-316, 2013 5) Faraglia V, Palombo G, Stella N, et al : Cerebral embolization during transcervical carotid stenting with flow reversal: a diffusion-weighted magnetic resonance study. Ann Vasc Surg 23: 429-435, 2009 7) Harada K, Morioka J, Higa T, et al : Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and evaluation of debris capture. Ann Vasc Surg 26: 929-936, 2012 3) Bonati LH, Jongen LM, Haller S, et al : New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9: 353-362, 2010 12) Tulip HH, Rosero EB, Higuera AJ, et al : Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting. J Vasc Surg 56: 1579-1584, 2012 4) Cremonesi A, Manetti R, Liso A, et al : Endovascular treatment of soft carotid plaques: a single-center carotid stent experience. J Endovasc Ther 13: 190-195, 2006 |
| References_xml | – reference: 12) Tulip HH, Rosero EB, Higuera AJ, et al : Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting. J Vasc Surg 56: 1579-1584, 2012 – reference: 2) Bijuklic K, Wandler A, Varnakov Y, et al : Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv 6: 311-316, 2013 – reference: 13) Yadav JS, Wholey MH, Kuntz RE, et al : Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351: 1493-1501, 2004 – reference: 7) Harada K, Morioka J, Higa T, et al : Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and evaluation of debris capture. Ann Vasc Surg 26: 929-936, 2012 – reference: 11) Stojanov D, Ilic M, Bosnjakovic P, et al : New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology. AJNR Am J Neuroradiol 33: 708-714, 2012 – reference: 6) Gupta N, Corriere MA, Dodson TF, et al : The incidence of microemboli to the brain is less with endarterectomy than with percutaneous revascularization with distal filters or flow reversal. J Vasc Surg 53: 316-322, 2011 – reference: 5) Faraglia V, Palombo G, Stella N, et al : Cerebral embolization during transcervical carotid stenting with flow reversal: a diffusion-weighted magnetic resonance study. Ann Vasc Surg 23: 429-435, 2009 – reference: 10) Schnaudigel S, Gröschel K, Pilgram SM, et al : New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39: 1911-1919, 2008 – reference: 4) Cremonesi A, Manetti R, Liso A, et al : Endovascular treatment of soft carotid plaques: a single-center carotid stent experience. J Endovasc Ther 13: 190-195, 2006 – reference: 8) Milosevic ZV, Kocijancic IJ, Bunc M, et al : Dual cerebral protection technique during carotid stenting. J Endovasc Ther 14: 86-90, 2007 – reference: 3) Bonati LH, Jongen LM, Haller S, et al : New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9: 353-362, 2010 – reference: 1) Bijuklic K, Wandler A, Hazizi F, et al : The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 59: 1383-1389, 2012 – reference: 9) Montorsi P, Caputi L, Galli S, et al : Microembolization during carotid artery stenting in patients with high-risk, lipid rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58: 1656-1663, 2011 |
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| Snippet | 「はじめに」 頚動脈ステント留置術(carotid artery stenting: CAS)は, 頚動脈狭窄症に対する手術的治療の中で頚動脈内膜剥離術(carotid endarterectomy: CEA)に対する選択肢の1つとして進歩し, 良好な成績が報告されることが増えてきた. しかし,... |
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| Title | Distal filterおよびproximal balloonによるdouble protection techniqueを用いたCASの有用性 |
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