颈动脉支架植入术中的栓塞保护策略:现状与展望。

IF 2.9 3区 医学 Q3 ENGINEERING, BIOMEDICAL Expert Review of Medical Devices Pub Date : 2023-05-01 DOI:10.1080/17434440.2023.2198124
Eligio Miccichè, Francesco Condello, Davide Cao, Alessia Azzano, Anna Maria Ioppolo, Andrea Mangiameli, Alberto Cremonesi
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引用次数: 0

摘要

简介:颈动脉血管成形术和支架置入术(CAS)是治疗颈动脉狭窄的一种成熟的手术,用于一级或二级预防卒中。随机临床试验显示,与颈动脉内膜切除术(CEA)相比,CAS术中脑血管事件的风险增加。已经提出了几种策略来减轻这种风险,包括替代血管通路、近端/远端栓塞保护装置和双层支架等。涵盖领域:本综述提供了目前CAS栓塞保护策略的总体概述。讨论了影响中风早期风险的手术阶段,以及如何使用新技术和设备降低中风风险。专家意见:器械技术的创新极大地提高了CAS的安全性和有效性。为了尽量减少与手术的差距,应该采取彻底的、以患者为导向的方法。血管内技术和技术应根据个人的情况选择,以解决独特的病变特征和血管解剖。细致的术前计划,临床和解剖,需要评估每一个程序的栓塞风险。只有深入了解各种可用的血管内设备和技术,操作人员才能选择最合适的策略来优化CAS结果。
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Procedural embolic protection strategies for carotid artery stenting: current status and future prospects.

Introduction: Carotid artery angioplasty and stenting (CAS) is an established procedure to treat carotid artery stenosis for either primary or secondary prevention of stroke. Randomized clinical trials have shown an increased risk of periprocedural cerebrovascular events with CAS compared with carotid endarterectomy (CEA). Several strategies have been proposed to mitigate this risk, including alternative vascular access site, proximal/distal embolic protection devices, and dual-layer stents, among others.

Areas covered: This review provides a general overview of current embolic protection strategies for CAS. The phases of the procedure which can affect the early risk of stroke and how to reduce it with novel techniques and devices have been discussed.

Expert opinion: Innovations in device technologies have dramatically improved the safety and efficacy of CAS. To minimize the gap with surgery, a thorough, patient-oriented approach should be pursued. Endovascular technologies and techniques should be selected on an individual basis to address unique lesion characteristics and vascular anatomies. Meticulous pre-procedural planning, both clinical and anatomical, is needed to assess the embolic risk of each procedure. Only by having an in-depth understanding of the wide range of available endovascular devices and techniques, the operator will choose the most appropriate strategy to optimize CAS results.

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来源期刊
Expert Review of Medical Devices
Expert Review of Medical Devices 医学-工程:生物医学
CiteScore
5.90
自引率
3.20%
发文量
69
审稿时长
6-12 weeks
期刊介绍: The journal serves the device research community by providing a comprehensive body of high-quality information from leading experts, all subject to rigorous peer review. The Expert Review format is specially structured to optimize the value of the information to reader. Comprehensive coverage by each author in a key area of research or clinical practice is augmented by the following sections: Expert commentary - a personal view on the most effective or promising strategies Five-year view - a clear perspective of future prospects within a realistic timescale Key issues - an executive summary cutting to the author''s most critical points In addition to the Review program, each issue also features Medical Device Profiles - objective assessments of specific devices in development or clinical use to help inform clinical practice. There are also Perspectives - overviews highlighting areas of current debate and controversy, together with reports from the conference scene and invited Editorials.
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