2017 年 11 巻 11 号 p. 592-596
Objective: Carotid artery stenting is performed increasingly with increases in atherosclerotic diseases. Since cerebral embolism is a problematic complication of stenting, preventive methods have been devised, and filters for distal protection have recently begun to be used. We have examined filters after the procedure and evaluated the relationships of the findings with preprocedural symptoms, imaging diagnosis, and flow impairment during treatment. While membrane filters have initially been used, mesh-type filters have also been introduced. Since mesh-type filters have an elastic structure in which wires are woven in, modifications of the conventional observation method are necessary.
Case Presentation: A 73-year-old man developed right hemiparesis and was referred to our department with a diagnosis of cerebral infarction. Marked stenosis was noted at the origin of the left internal carotid artery and was considered a responsible lesion as a result of close examination. On the 26th day of illness, stent placement was performed using a mesh-type filter. After stent placement, the filter was stained with hematoxylin and eosin. The mesh part was cutoff, mounted on a glass slide, a mounting medium was dripped, and a cover glass was applied. Both sides of the cover glass were fixed with clips. After the embedding medium dried (about 1 week), the clips were removed, and the completed preparation was examined microscopically. Many pieces of thrombotic debris were captured. At high magnification, organized components and slight precipitation of fibrin were also observed.
Conclusion: Examination of filters is useful because it makes the evaluation of debris properties and their relationships with preprocedural images and intraprocedural complications possible.