Hemodynamic compromise を有する症例における頚動脈ステント留置術の治療成績

Abstract

We reviewed the treatment results of cervical carotid artery stenting (CAS) for carotid stenosis with cerebral hemodynamic compromise evaluated by 123I-IMP single photon emission computed tomography (SPECT). We treated 10 cases of carotid stenosis with Stage II hemodynamic cerebral ischemia. Hemodynamic compromise was diagnosed by pre-treatment resting and acetazolamide-activated CBF-SPECT using 123I-IMP. There were 5 cases of symptomatic and 5 cases of asymptomatic carotid stenosis. Post-treatment CBF was evaluated 7 days after the procedure. In all cases, pre-operative Stage II hemodynamic compromise was improved at post-procedure SPECT. There were no cases of hyperperfusion syndrome (HPS), intracerebral hemorrhage or ischemic complications during or after the procedure. In patients with ipsilateral Stage II cerebral ischemia, the peri-operative countermeasure against HPS is very important. And in patients with contralateral side Stage II cerebral ischemia, it is necessary to consider how to cope with bradycardia and hypotension to prevent peri-procedural cerebral infarction.