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Neurological Surgery No Shinkei Geka Volume 36, Issue 12 （December 2008）

Neurological Surgery 脳神経外科 36巻12号（2008年12月発行）

Japanese English

症例

Embolus protection filterを用いたステント留置術中にfilter obstructionを来した内頸動脈狭窄症の1例 A Case of Internal Carotid Artery Stenosis Complicated with Filter Obstruction during Carotid Artery Stenting with an Embolus Protection Filter 林健太郎 ¹ , 北川直毅 ¹ , 森川実 ² , 日宇健 ¹ , 諸藤陽一 ¹ , 陶山一彦 ¹ , 永田泉 ¹ Kentaro HAYASHI ¹ , Naoki KITAGAWA ¹ , Minoru MORIKAWA ² , Takeshi HIU ¹ , Yoichi MOROFUJI ¹ , Kazuhiko SUYAMA ¹ , Izumi NAGATA ¹ ¹長崎大学医学部脳神経外科 ²長崎大学医学部放射線科 ¹Department of Neurosurgery Nagasaki University School of Medicine ²Department of Radiology,Nagasaki University School of Medicine キーワード： carotid artery stenting , debris , embolus protection filter , filter obstruction Keyword: carotid artery stenting , debris , embolus protection filter , filter obstruction pp.1133-1138

発行日 2008年12月10日 Published Date 2008/12/10

DOI https://doi.org/10.11477/mf.1436100856

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参考文献 Reference

Ⅰ．はじめに

　頸動脈ステント留置術における脳塞栓の予防は必須と考えられている^10,11,13)．本邦では主にバルーンによる血流遮断法が用いられてきたが²⁾，頸動脈ステントが薬事承認され，embolus protection filterによるdistal protectionが広まりつつある．Filter deviceは血流を温存できるのが最大の利点であるが，filterのporeは小さく，debrisが多い場合などには血流障害を来すことがある．今回，われわれはembolus protection filterを用いたステント留置術中にfilter obstructionとなり，一過性の神経脱落症状を来した症例を経験した．Filterの組織学的所見をふまえてその病態を検討する．

　The SAPPHIRE trial has established carotid artery stenting (CAS) in high-surgical-risk patients as an effective alternative to carotid endarterectomy. Since the occurrence of distal embolization with CAS is still a major concern, an embolus protection device is usually employed during the procedure. Although the advantage of the filter device is continuation of blood flow during the procedure, blood flow is occasionally reduced due to plaque debris or thrombus. Here, we report a case of internal carotid artery (ICA) stenosis complicated with filter obstruction during CAS.

　A 74-year-old woman who had a history of coronary artery stenting was referred to our hospital for the treatment of carotid artery stenosis. Angiography showed occlusion of the right ICA and high-grade stenosis at the origin of the left ICA. Since cerebral circulation was impaired significantly in the left cerebral hemisphere, CAS was performed for the left ICA stenosis using an embolus protection filter. Self-expandable stent was placed into the left ICA following predilation. The patient developed consciousness disturbance and right hemiparesis during postdilation. Angiography showed impairment of blood flow, indicating filter obstruction. The debris containing blood stasis was removed with an aspiration catheter and the flow was restarted retrieving the filter. The symptom recovered within one hour. Appropriate antithrombotic therapy and preparation for filter obstruction such as the provision of an aspiration catheter are important in CAS using an embolus protection filter.