椎骨動脈起始部狭窄に対する経皮的血管形成術で生じた塞栓子の検出  [in Japanese] The Detection of Debris Caused by Percutaneous Transluminal Angioplasty of Vertebral Artery Origin Stenosis  [in Japanese]

Recent studies have shown that percutaneous transluminal angioplasty (PTA) of vertebral artery origin stenosis (VAS) is safe and effective. On the other hand, a major concern about the procedure involves the risk of embolic phenomena. But there have been no studies detecting debris during the PTA of VAS. We reviewed 20 patients to examine the distal embolism of debris caused by the procedure. Twenty patients (2 female, 18 male) with a mean age of 65.3 years (range 49 to 78 years) underwent treatment with the PTA of VAS. Among 20 cases, a protection device was used in 11 cases (distal protection: 7 cases, proximal protection: 4 cases). In the distal protective balloon technique, the protective balloon was set so as to occlude the stenotic artery distally. In this technique, we sucked up the blockaded blood that was likely to contain debris and confirmed existence of debris. In the proximal protective technique, the protective balloon was set so as to occlude the proximal subclavian artery. In all 20 cases, there was no ischemic event during the procedure. In 6 of 7 cases with distal protection, micro debris could be found in blood samples. Our report clearly shows for the first time that debris is often induced by PTA of VAS, and protection device works effectively during the procedure. Safer PTA can be performed using a protective device.