大動脈上部動脈狭窄症に対するｓｔｅｎｔｉｎｇ―Ｍｏｕｓｅ Ｔｒａｐ法の応用による血栓／塞栓の予防―

Abstract

For the supra-aortic atherosclerotic stenoses, neurovascular and neuro-interventional approaches have been performed. Interventional approaches have risk of thrombo-embolic events, while vascular approaches have surgical stress. We developed and applied a method for cerebral protection for stenting of supra-aortic stenoses and introduce our method in this article. We performed stenting in 20 supra-aortic stenoses from April 2006 to March 2008. Our cerebral protection method, a modified application of the “Mouse Trap” (“Mouse in a Trap”) method usually used for CAS patients, was applied for 5 patients (1 CCA origin stenosis, 1 brachio-cephalic artery stenosis, 1 SA stenosis, 1 VA V3-V4 stenosis, 1 ICA petrous segment stenosis). The stenotic lesion was dilated and stented, while the lesion was endovascularily trapped with the occlusion balloon and so on. After each manipulation (predilation, stenting, post-dilation), the blood with the clots and debris was aspirated, filtrated, and returned to the body via the vein. We modified the method for supra-aortic stenotic lesions according to their anatomical location, but maintained the principle of the “Mouse Trap” method. In all 5 cases, the protection procedure was done without worsening of clinical findings. However, high intensity areas on DWI were subclinically found in 2 patients. Although this study covered only a small number of cases, non-CAS supra-aortic atherosclerotic stenoses cases were safely stented under a modified “Mouse Trap” cerebral protection system.