대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제81권3호
  • /
  • Pages.739-745
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  • 2020
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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취약한 죽상경화반의 원위 필터형 색전예방장치를 이용한 내경동맥의 스텐트 시술 후 발생한 다량의 뇌 미세혈전: 증례 보고

Massive Cerebral Microemboli after Protected Carotid Artery Angioplasty and Stenting Using a Distal Filter Embolic Protection Device for a Vulnerable Plaque with a Lipid Rich Necrotic Core and Intraplaque Hemorrhage: A Case Report

  • 김혜정 (성균관대학교 의과대학 강북삼성병원 영상의학과) ;
  • 노명호 (성균관대학교 의과대학 강북삼성병원 영상의학과)
  • Hae-Jung Kim (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Myung-Ho Rho (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2019.05.10
  • 심사 : 2019.09.27
  • 발행 : 2020.05.01
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초록

경동맥 혈관성형술 및 스텐트삽입술과 관련된 주요 합병증은 시술 도중 발생하는 원위부 뇌색전증으로 이를 방지하기 위해 색전예방장치가 개발되었다. 그러나 취약한 죽상경화반을 가진 환자의 경우 색전예방장치를 사용한 경동맥 혈관성형술 및 스텐트삽입술 후 뇌 색전증의 위험은 논란의 여지가 있으며, 색전예방장치의 사용에도 불구하고 무증상 또는 증상이 있는 뇌졸중이 발생한다. 저자들은 지방이 풍부한 괴사성 핵과 경화반 내 출혈이 있는 취약한 죽상경화반의 원위 필터형 색전예방장치를 이용한 내경동맥의 스텐트 시술 후 발생한 다량의 뇌 미세혈전의 증례를 보고하고자 한다.

A major concern associated with carotid artery angioplasty and stenting (CAS) is a periprocedural distal cerebral embolization. To prevent distal embolization, embolic protection devices (EPDs) have been developed. However, the risk of cerebral embolism after protected CAS in patents with a vulnerable plaque is controversial and either a silent or a symptomatic stroke can occur despite the use of EPDs. Here, we report a case of a massive cerebral microemboli after a protected CAS using a distal filter EPD for a vulnerable plaque with a lipid rich necrotic core and intraplaque hemorrhage.

키워드

참고문헌

  1. Noiphithak R, Liengudom A. Recent update on carotid endarterectomy versus carotid artery stenting. Cerebrovasc Dis 2017;43:68-75 
  2. Rosenkranz M, Fiehler J, Niesen W, Waiblinger C, Eckert B, Wittkugel O, et al. The amount of solid cerebral microemboli during carotid stenting does not relate to the frequency of silent ischemic lesions. AJNR Am J Neuroradiol 2006;27:157-161 
  3. Saba L, Sanfilippo R, Sannia S, Anzidei M, Montisci R, Mallarini G, et al. Association between carotid artery plaque volume, composition, and ulceration: a retrospective assessment with MDCT. AJR Am J Roentgenol 2012;199:151-156 
  4. Yoshimura S, Yamada K, Kawasaki M, Asano T, Kanematsu M, Takamatsu M, et al. High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 2011;42:3132-3137 
  5. Chung GH, Jeong JY, Kwak HS, Hwang SB. Associations between cerebral embolism and carotid intraplaque hemorrhage during protected carotid artery stenting. AJNR Am J Neuroradiol 2016;37:686-691 
  6. Mousa AY, Campbell JE, Aburahma AF, Bates MC. Current update of cerebral embolic protection devices. J Vasc Surg 2012;56:1429-1437 
  7. Siewiorek GM, Wholey MH, Finol EA. A comparative analysis of bench-top performance assessment of distal protection filters in transient flow conditions. J Endovasc Ther 2012;19:249-260 
  8. Masuda J, Yutani C, Ogata J, Kuriyama Y, Yamaguchi T. Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases. Neurology 1994;44:1231-1237 
  9. Casserly IP, Abou-Chebl A, Fathi RB, Lee DS, Saw J, Exaire JE, et al. Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome. J Am Coll Cardiol 2005;46:1466-1472 
  10. Texakalidis P, Letsos A, Kokkinidis DG, Schizas D, Karaolanis G, Giannopoulos S, et al. Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: a systematic review and meta-analysis. Cardiovasc Revasc Med 2018;19:545-552