不安定プラークを伴った頚動脈狭窄症に対するクローズセルステントを用いたステントインステント法による頚動脈ステント留置術

Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.博士（医学）・乙第1444号・令和元年12月5日This is a non-final version of an article published in final form in "https://doi.org/10.1177/1526602819847698

鎖骨下動脈閉塞性動脈硬化症に対する血管内超音波評価を併用したステント留置術の長期治療成績

The objective of this study was to determine long-term outcomes after stent placement for subclavian artery (SA) obstructive lesions assisted by intraoperative intravascular ultrasound (IVUS). The study included 25 lesions in 24 patients who underwent stent placement assisted by intraoperative IVUS for subclavian artery stenosis or obstruction at our hospital between January 2003 and August 2010. Outcome was evaluated based on the results within 30 postoperative days (technical success rate, improvement in upper extremity ischemia, steal syndrome, left-right blood pressure difference, and perioperative complications) and the results after 30 postoperative days (incidence of vertebrobasilar artery territory infarction and restenosis). Stent placement and vessel dilatation were successful in all patients, without perioperative complications. Upper extremity ischemia, steal syndrome, and left-right blood pressure difference disappeared in all cases. During follow-up observation (6-96 months; median 51 months), no restenosis occurred at the stent placement site in any patient. In one case, four years after initial treatment, stenosis was noted proximal to the stent placement site. Satisfactory long-term as well as short-term outcomes were achieved after stent placement for SA obstructive lesions assisted by intraoperative IVUS evaluation.博士（医学）・乙第1362号・平成27年5月28日Copyright © 2014 by SAGE Publications. The definitive version is available at " http://dx.doi.org/10.15274/NRJ-2014-10023