文档介绍：Carotid Artery Stenting Under Neuroprotection Device
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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
Paul HL Kao
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Procedural embolism
The most common 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
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Symptomatic right ICAS
Paul HL Kao
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Symptomatic right ICAS
Left arm weakness during procedure
Plain CT 3hr post stenting
Plain CT 2 days post stenting
Paul HL Kao
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Ideal protection device
Complete interception of the emboli
Maintain cerebral perfusion
Good handling characteristics
Intuitive and compatible 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
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Partial list of current EPD
Proximal occlusion
Invatec MoMA
ArteriA PAES
Velocimed Proxis
Distal occlusion
Medtronic/PercuSurge GuardWire Plus
Kensey Nash TriActiv
Rubicon Medical Guardian
Mesh filter
Medtronic/AVE MDT Interceptor
Microvena TRAP
Ev3 SPIDER
Supported membrane filter
Abott/Mednova Emboshield
Cordis Angioguard XP
Guidant Accunet
SCION SCIPro
Unsupported membrane filter
BSC FilterWire EX/EZ
Metamorphic E-Sack/E-Trap
Intra Therapeutics Sulzer-Intraguard
Rubicon Filter
Paul HL Kao
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Distal occlusion
Balloon-tipped wire crosses lesion
Inflation before angioplasty to stop anterograde flow
Debris released stayed in the stagnant column of blood
Aspiration to remove debris
Paul HL Kao
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Advantage and drawback