중증의 경동맥 협착 치료를 위한 스텐트 설치술시 색전방지기구(Filterwire)의 치료 성적 = Results of Carotid Artery Stenting using Filter Wire in 24 Consecutive Symptomatic Patients with Severe Stenosis

다국어 초록 (Multilingual Abstract)

Purpose: The aims of this study were to analyze the results of carotid artery stenting using distal protection with FilterWire, and evaluate the effectiveness of FilterWire for distal embolic protection.
Materials and Methods: Between June and December in 2004, elective carotid artery stenting using FilterWire was attempted in 25 lesions of 24 consecutive patients. All patients were symptomatic, with recurrent transient ischemic attacks (TIA) or a stroke. The cerebral ischemic lesions of embolic origin were evaluated before and after the procedure using magnetic resonance imaging, including diffusion-weighted images. Both preand post-procedural 99mcTc-ECD SPECT were performed to assess the cerebral blood flows. Any visible debris within the FilterWire was sent for histological/cytological analyses.
Results: Technical success was achieved all 25 cases. The mean pre-procedural stenosis was 89% (range 70-100%), and that immediately after stent placement was nearly 0%. With the exception of only one major stroke (1/25, 4%), no periprocedural complications were encountered. On the diffusion weighted images, new lesions were observed in four patients (4/25, 16%), but these were clinically silent. FilterWire-related transient spasm occurred in eight of the 25 procedures (32%).
Conclusion: Carotid artery stenting, with FireWire distal protection, seems technically feasible, safe and effective in preventing procedural related embolic complications.

국문 초록 (Abstract)

목 적: 본 연구는 중증의 경동맥협착을 가진 환자에서 Filterwire 색전방지기구를 이용한 스텐트 설치술의 결과를 분석하고, Filterwire 색전방지기구가 경동맥 스텐트 설치술시에 급성합병증을 줄이는데 유용한지를 알아보고자 하였다.
대상과 방법: 2004년 6월부터 12월까지 Filterwire를 이용한 경동맥 스텐트 설치술을 시행한 24명의 환자에서 25개 병변을 대상으로 분석하였다. 시술전과 시술 후에 확산강조영상을 포함하는 뇌 자기공명영상을 시행하여 시술 후 새로운 색전병변의 유무를 평가하였다. 또한, 단일광자방출 전산화 단층영상을 시행하여 시술 후 뇌혈류의 변화를 평가하였다.
결과: 모든 25예에서 성공적으로 스텐트설치술이 이루어졌으며, 시술 전 평균 협착은 89%(70-100%), 시술직후 평균 협착은 거의 0%로, 100%의 기술적인 성공을 이루었다. 30일 추적관찰에서 시술과 관련된 합병증은 1예(1/25, 4%)가 있었다. 4예(4/25, 16%)에서 술 후 확산강조 자기공명영상에서 새로운 색전병변이 관찰되었으나, 임상적인 증상은 없었다. 시술 후 단일광자방출 전산화 단층촬영에서 뇌혈류와 뇌혈관반응성이 회복되는 소견을 보였다. 8예에서 Filterwire와 관련된 원위부 내경동맥의 일과성 연축이 있었다(8/25, 32%).
결론: Filterwire 색전방지기구를 이용한 경동맥 스텐트 설치술은 기술적으로 적용가능하고, 안전하며, 시술과 관련된 색전 합병증을 줄이는데 매우 효과적이었다.

참고문헌 (Reference)

1 "et al.Early outcome of carotid angioplasty and stenting with andwithout cerebral protection devices" 34 : 813-819, 2003

2 "Transcranial Doppler detection of microemboli during percuta-neous transluminal angioplasty" 29 : 2367-2370, 1998

3 "Stenting and Angioplasty with Protection in Patients at HighRisk for Endarterectomy (SAPPHIRE)" Chicago, III: American HeartAssociation 2002

4 "Role of distal protection during carotid stenting" 15 : 499-504, 2002

5 "Results of a multicenter prospective randomized trialof carotid artery stenting versus carotid endarterectomy" 32 : 325-, 2001

6 "Protected carotid stenting:clinical advantages and complicationsof embolic protection devices in 442 consecutive patients" 34 : 1941-1943, 2003

7 "Postprocedural hypotension after carotid artery stent place-ment:predictors and short- and long-term clinical outcomes" 215 : 677-683, 2000

8 "Microemboli detected by transcranial Dopplermonitoring in patients during carotid angioplasty versus carotidendarterectomy" 7 : 33-38, 1999

9 "Initial multicenter experience with a novel distalprotection filter during carotid artery stent implantation" 58 : 139-146, 2003

10 "Impact of cerebral protection devices on early outcome ofcarotid stenting" 9 (9): 786-792, 2002

11 "Immediate and late clinical outcomes of carotidartery stenting in patients with symptomatic and asymptomaticcarotid artery stenosis:5-year prospective analysis" 103 : 532-537, 2001

12 "Endovascular versus surgical treatment in patients with carotidstenosis in the Carotid and Vertebral Artery TransluminalAngioplasty Study (CAVATAS) a randomized trial" 357 : 1729-1737, 2001

13 "Diffusion-weighted MR imaging after angioplasty or angio-plasty plus stenting of arteries supplying the brain" 22 : 1251-1259, 2001

14 "Complication with anembolic protection device during carotid angioplasty" 62 : 234-236, 2004

15 "Comparison of hemodynamic cerebral ischemia andmicroembolic signals detected during carotid angioplasty" 28 : 2460-2464, 1997

16 "Cerebral protection with filter devices during carotid arterystenting" 104 : 12-15, 2001

17 "Cerebral ischemia detected with diffusion-weight-ed MR imaging after stent implantation in the carotid artery" 23 : 200-207, 2002

18 "Carotidartery stenting: technical considerations" 21 (21): 1736-1743, 2000

19 "Carotid artery stenting:currentstatus and future directions" 37 : 315-322, 2003

20 "Carotid artery stenting with routine cerebral protection in highrisk patients" 188 : 644-652, 2004

21 "Carotid artery stenting protected with an emboli contain-ment system" 33 (33): 1308-1314, 2002

22 "Carotid artery stenosis:treatment with protected balloon angio-plasty and stent placement" 201 : 627-636, 1996

23 "Carotid an-gioplasty and stenting with and without cerebral protection: clini-cal alert from the endarterectomy versus angioplasty in patientswith symptomatic severe carotid stenosis (EVA-3S) trial" 35 : 18-20, 2004

24 "Carotid PTA and StentingCollaborative Research Group.New brain lesions at MR imagingafter carotid angioplasty and stent placement" 224 : 361-365, 2002

25 "Cardiac autonomic control during balloon carotidangioplasty and stenting" 81 : 944-951, 2003

26 "Belgian experience with FilterWire EX in the prevention ofembolic events during carotid stenting" 10 : 695-701, 2003

27 "An in vitro analysis of a carotid artery stent with aprotective porous membrane" 15 : 1295-1305, 2004

28 "A com-parison of angioplasty with stenting versus endarterectomy for thetreatment of carotid artery stenosis" 11 : 2-8, 1997