文档介绍：Carotid Artery Stenting Under Neuroprotection Device
Carotid artery stenosis
Atherosclerotic plaque formation at carotid bifurcation
Plaque ulceration, thrombus formation, and distal embolism is the major mechanism causing symptoms
Carotid stenting (CS) has been reported since 1987 as an alternative to endarterectomy
However, unprotected CS carries 5-10% risk of procedural stroke
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Procedural embolism
The mon mechanism for procedural stroke
Embolic materials can be released in all steps during CS in almost every case
Particles obstructing critical vessels result in symptoms, but may also be silent with unknown long-term effect
Embolic protection device (EPD) may therefore be mandatory in CS
Paul HL Kao
Symptomatic right ICAS
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Symptomatic right ICAS
Left arm weakness during procedure
Plain CT 3hr post stenting
Plain CT 2 days post stenting
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Ideal protection device
Complete interception of the emboli
Maintain cerebral perfusion
Good handling characteristics
Intuitive patible with existing procedure and equipment
No sizing limitation
Safe and effective in clinical studies
But, IDEAL EPD is non-existing in the real world
Paul HL Kao
Advantage and drawback
Better crossing profile than other distal devices
One size fits all (3-6 mm)
Embolic particle size irrelevant
Lesion has to be crossed first
Patient tolerance
Time pressure on the operator
Potential distal ICA trauma
Distal filter
Filter crosses the lesion
Filter deployed before angioplasty
Anterograde flow maintained while debris released stopped by the filter
Final retrieval of the filter with the trapped debris
Paul HL Kao