著者
Yoichi Yoshida Yosuke Tajima Masaaki Kubota Eiichi Kobayashi Akihiko Adachi Yasuo Iwadate
出版者
The Japanese Society for Neuroendovascular Therapy
雑誌
Journal of Neuroendovascular Therapy (ISSN:18824072)
巻号頁・発行日
pp.oa.2022-0017, (Released:2022-11-01)
参考文献数
14

Objective: In radiation-induced carotid artery stenosis (RIS), morphological characteristics, such as bilateral and long lesion distances and in-stent stenosis, have been reported as common after carotid artery stenting (CAS). Here, we present 25 cases at our hospital wherein CAS was performed for RIS and compare the morphological characteristics and the safety of the treatment with cases of atherosclerotic carotid artery stenosis (AS).Methods: Twenty-five lesions from 21 patients underwent CAS for RIS at our hospital between March 2002 and July 2020. The procedure was performed at a mean of 10.0 ± 5.2 years after radiation therapy with 60–72 Gy, with a median follow-up of 45 months. We retrospectively selected consecutive patients with AS with comparable follow-up times from the beginning of the study as controls. We compared the patients’ background, stenosis findings including plaque MRI, perioperative period, and postoperative course.Results: All patients in both groups completed the procedure, and the median follow-up time for the RIS and AS groups was 45 and 40 months, respectively (p = 0.1479). Patients in the RIS group had a lower mean age (69.9 ± 6.9 vs. 75.3 ± 7.04, p = 0.0075), a higher stenosis rate (79.1 ± 8.7% vs. 68.6 ± 11.7%, p = 0.0032), and longer stenosis greater than one vertebra (long lesions) (10 vs. 1, p = 0.0046) compared with the patients in the AS group. Although there was no significant difference in outcomes between the two groups, restenosis tended to be more common in the RIS group. Plaque MRI was characterized by a significantly higher T2WI signal (p = 0.0381) in the RIS group, which was attributable to the fact that a necrotic core has been reported commonly in the plaque tissue of RIS.Conclusion: RIS has a high likelihood of restenosis both morphologically and in terms of plaque characteristics. Thus, close follow-up is crucial.
著者
Yoichi Yoshida Eiichi Kobayashi Masaaki Kubota Akihiko Adachi Yasuo Iwadate
出版者
The Japanese Society for Neuroendovascular Therapy
雑誌
Journal of Neuroendovascular Therapy (ISSN:18824072)
巻号頁・発行日
vol.16, no.2, pp.106-115, 2022 (Released:2022-02-20)
参考文献数
20

Objective: We herein report two cases of transient cerebral vasoconstriction after carotid artery stenting (CAS).Case Presentation: An 81-year-old man presented with asymptomatic severe stenosis in the right carotid artery accompanied by a slight reduction in cerebrovascular reactivity. CAS was performed, but the patient had a generalized seizure because of transient cerebral ischemia caused by intolerance to carotid artery occlusion with balloon protection. Confusion and left hemiparesis persisted. DSA suggested cerebral ischemia due to vasoconstriction as the cause of these prolonged symptoms. A 66-year-old man presented with asymptomatic severe stenosis in the right carotid artery with slight hypoperfusion. CAS was performed. The patient developed left hemispatial neglect, dysarthria, and left hemiparesis 12 hours after the procedure. DSA revealed cerebral vasoconstriction in the responsible territory. The conditions of both patients improved within several days with medical treatment and they were discharged without neurological deficits.Conclusion: The cases presented herein show that transient ischemic complications caused by cerebral vasoconstriction may develop after CAS.
著者
Akihiko Adachi Eiichi Kobayashi Ken Kado Naokatsu Saeki
出版者
The Japanese Society for Neuroendovascular Therapy
雑誌
Journal of Neuroendovascular Therapy (ISSN:18824072)
巻号頁・発行日
vol.10, no.5, pp.236-242, 2016 (Released:2016-11-30)
参考文献数
8
被引用文献数
7 5

Objectives: Manual shaping of a straight microcatheter is required when guiding or retention of a microcatheter with a pre-shaped tip is difficult. According to the manufacturer’s instructions, it is recommended that the microcatheter be shaped by steaming “for 30s” and “25 mm away from the steam source”. However, insufficient shaping and blunting can occasionally occur during the procedure. In this technical note, we present the optimal conditions of shaping for a microcatheter system.Methods: In this study, we used a hot air gun (BOSCH, Gerlingen, Germany) as the shaping source and a Headway microcatheter (Microvention, CA, USA; Terumo, Tokyo, Japan). After measuring the difference between the preset and the actual temperature value, shaping was performed at different temperatures (preset temperature of 110°C–140°C) and time intervals (30s–120s).Results: The actual temperature was constant at 20°C below the preset temperature, at a distance of 2.5 cm from the hot air outlet. We performed shaping at a preset temperature of 110°C–140°C (i.e., 90°C–120°C actual temperature) for 30s–120s. Because the Headway microcatheter could not tolerate preset temperature higher than 130°C (i.e., actual temperature of 110°C), the distal tip fluffed, bubbled, and perforated. We examined the durability under each condition, comparing the shape just after mandrel removal, after micro-guidewire manipulation, and after stretching in a vascular model. The highest moldability and durability were achieved at a time interval of 90s–120s, and a preset temperature of 120°C (i.e., 100°C actual temperature).Conclusion: The Headway microcatheter showed the best performance at a heating time of 90s and a preset temperature of 120°C (i.e., 100°C actual temperature) in hot air gun shaping, although the optimal temperature and time interval may vary with the used microcatheter, depending on each instrument structure and materials.