抄録
In our previous standard CAS procedure, we selected the intended predilatation balloon, stent, and postdilatation balloon in advance, before treatment got under way. The sizes were chosen according to images captured from 3D-DSA. From April 2003 to March 2004, we treated 17 patients using this method, with which predilatation, stent deployment and postdilatation were done successively under one-time occlusion of the ICA using the PercuSurge GuardWire device (Medtronic Vascular, Santa Rosa, CA). In the 4 patients of this series, the postdilatation balloon was too small to obtain adequate vessel diameter, requiring re-postdilatation.
In our modified procedure, however, only the intended predilatation balloon and stent are prepared in advance. After predilation and deployment of the stent in the lesion, an aspiration catheter is used to aspirate possibly dislodged emboli. The occlusion balloon is then deflated and antegrade flow is restored, while the aspiration catheter is removed followed by the intravascular ultrasound sonography. This study aids us to determine the appropriate postdilatation balloon size by measurements done after stent deployment. From April 2004 to March 2005, 18 patients were treated with this method. Not 1 patient needed re-postdilatation, and we henceforth made this our new standard procedure.
Although the exact mechanism is unknown, the periprocedural rate of cerebral ischemic events has become lower with this new procedure.
