頚動脈ステントに対する新しいｄｉｓｔａｌ ｐｒｏｔｅｃｔｉｏｎ ｓｙｓｔｅｍ−ＰｅｒｃｕＳｕｒｇｅ ＧｕａｒｄＷｉｒｅ Ｓｙｓｔｅｍの使用経験−

Abstract

Carotid artery stenting (CAS) has emerged as an endovascular treatment for obstructive extracranial carotid artery disease. Despite advanced stenting techniques, neurological events linked to embolization of the particulate material in cerebral circulation occur in 5% of cases. A distal balloon protection system is increasingly being used to prevent cerebral atheroembolism during CAS procedures. In this study, we examined the possible beneficial effect of a new cerebral protection device (PercuSurge occlusion balloon) based on balloon occlusion of the distal internal carotid artery (ICA) and debris aspiration for patients undergoing postdilation. Eight patients underwent CAS using the PercuSurge GuardWire system. SMART stents were employed after predilation. The protective balloon was then introduced into the carotid artery, and advanced across the lesion. After postdilation, the PercuSurge Export aspiration catheter with proximal vacuum syringe was advanced toward the occlusion balloon. With suction applied, this catheter was advanced and retracted several times. In the 8 patients, the mean stenosis rate before stenting, 82.6%, markedly decreased to 8.8% after the procedure. The debris containing atheromatous emboli was removed by aspiration. On diffusion-weighted MRI, hyperintense areas were detected in 3 of the 8 patients. No complication related to the procedures occurred. Stenting with the PercuSurge GuardWire system for cervical ICA stenosis is an effective therapeutic modality. Protection devices may play an important role in future carotid interventions and expand the applicability of the procedure.