Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter
Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter
复制标题
使用栓子保护过滤器进行颈动脉支架置入术期间血流损伤的病理生理学
DOI：
10.1007/s00701-014-2180-z
复制
发表时间：
2014
期刊：
影响因子：
2.4
通讯作者：
Hayshi K et al.
中科院分区：
文献类型：
--
作者：
宗剛平;中川慎介 他９名;Hayshi K et al.
颈动脉支架置入术（CAS）是治疗颈动脉粥样硬化性狭窄的一种公认的治疗方法。由于CAS远端栓塞的发生仍然是一个主要问题，因此在手术过程中通常使用栓子保护装置（EPD）。我们检查了两种类型的栓子保护滤器（Angioguard XP（AG）; Filterwire EZ（FW））并评价了功能。因此，过滤器进行检查，术后和术中血流障碍的原因evaluated.Materials和methodsCAS进行了54例颈动脉狭窄（55病变：25 AG; 27 FW; 3人）。完成CAS后，用苏木精-伊红（HE）溶液对滤膜进行染色，并从滤器支柱上取下。一旦安装在载玻片上，在显微镜下评价过滤器。测量碎片占据的面积，并评价与术中血流损伤的关系。此外，围手术期缺血并发症和术中血流impairment.ResultsMicroscopic观察的幻灯片之间的关系进行了统计学分析显示，FW的孔密度是1.5倍高于AG和过滤面积的FW是2.5倍，比AG宽。HE染色有助于碎片组成的表征。AG（0.241 ±0.13 cm 2）中碎片占据的面积显著大于FW（0.129 ±0.093 cm 2）。因此，纤维蛋白在AG中明显更多地沉淀。AG组6例（24.0%），FW组4例（14.8%）出现血流障碍.它是由AG中的滤过器阻塞和FW中的血管痉挛引起的。AG组3例（12.0%）并发脑梗死，均与血流障碍有关。1例FW病例（3.7%）在整个介入过程中保留血流时并发脑梗死。AG组的血流受损原因是滤器阻塞，FW组的血流受损原因是血管痉挛。滤器阻塞往往导致脑梗塞。
ObjectiveCarotid artery stenting (CAS) is a well-accepted treatment for atherosclerotic stenosis of carotid arteries. Since the occurrence of distal embolization with CAS is still a major concern embolus protection devices (EPD) are usually employed during the procedure. We examined two types of embolus protection filters (Angioguard XP (AG); Filterwire EZ (FW)) and evaluated the function. Thus, the filter was examined postoperatively and the cause of intraoperative flow impairment was evaluated.Materials and methodsCAS was performed for 54 patients with carotid artery stenosis (55 lesions: 25 AG; 27 FW; 3 others). After completing CAS the filter membrane was stained with hematoxylin-eosin (HE) solution and removed from the filter strut. Once mounted on a glass slide the filter was evaluated under a microscope. The area occupied with debris was measured and the relationship to intraoperative flow impairment was evaluated. Furthermore, the relationship between perioperative ischemic complications and intraoperative flow impairment was statistically analyzed.ResultsMicroscopic observation of the slide revealed the pore density of the FW was 1.5 times higher than that of the AG and the filter area of the FW was 2.5 times wider than than the AG. HE staining facilitated characterization of the debris composition. The area occupied with debris was significantly more in the AG (0.241 ±0.13 cm2) than in the FW (0.129 ±0.093 cm2). Thus, fibrin was significantly more precipitated in the AG. Flow impairment occurred in 6 AG cases (24.0 %) and 4 FW cases (14.8 %). It was induced by filter obstruction in the AG and by vasospasms in the FW. Three cases treated with AG (12.0 %) were complicated with cerebral infarction and all of them were related to flow impairment. One FW case (3.7 %) was complicated with cerebral infarction in presence of preserved flow throughout the intervention.ConclusionFilter function is different according to each design. The cause of flow impairment was attributable to filter obstruction in the AG group and to vasospasms in the FW group. Filter obstruction tends to result in cerebral infarction.