在保护伞下放置支架经典.pptVIP

Carotid Artery Stenting Under Neuroprotection Device Carotid artery stenosis Atherosclerotic plaque formation at carotid bifurcation Plaque ulceration, thrombus formation, and distal embolism is the major mechanism causing symptoms Carotid stenting (CS) has been reported since 1987 as an alternative to endarterectomy However, unprotected CS carries 5-10% risk of procedural stroke Procedural embolism The most common mechanism for procedural stroke Embolic materials can be released in all steps during CS in almost every case Particles obstructing critical vessels result in symptoms, but may also be silent with unknown long-term effect Embolic protection device (EPD) may therefore be mandatory in CS Symptomatic right ICAS Symptomatic right ICAS Ideal protection device Complete interception of the emboli Maintain cerebral perfusion Good handling characteristics Intuitive and compatible with existing procedure and equipment No sizing limitation Safe and effective in clinical studies But, IDEAL EPD is non-existing in the real world Partial list of current EPD Proximal occlusion Invatec MoMA ArteriA PAES Velocimed Proxis Distal occlusion Medtronic/PercuSurge GuardWire Plus Kensey Nash TriActiv Rubicon Medical Guardian Mesh filter Medtronic/AVE MDT Interceptor Microvena TRAP Ev3 SPIDER Supported membrane filter Abott/Mednova Emboshield Cordis Angioguard XP Guidant Accunet SCION SCIPro Unsupported membrane filter BSC FilterWire EX/EZ Metamorphic E-Sack/E-Trap Intra Therapeutics Sulzer-Intraguard Rubicon Filter Distal occlusion Balloon-tipped wire crosses lesion Inflation before angioplasty to stop anterograde flow Debris released stayed in the stagnant column of blood Aspiration to remove debris Advantage and drawback Better crossing profile than other distal devices One size fits all (3-6 mm) Embolic particle size irrelevant Lesion has to be crossed first Patient tolerance Time pressure on the operator Potential distal ICA trauma Distal filter Filter crosses the lesion F