Efficacy of Direct Road Mapping with Combined Use of Mo.Ma Ultra and PercuSurge GuardWire for Carotid Artery Stenting

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  • CAS施行時における，Mo.Ma UltraとPercuSurge GuardWireを併用したdirect road mappingの有用性の検討

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Objective: We designed a direct road map method during carotid artery stenting (CAS) in March 2015. We evaluated the effectiveness of this method for 13 lesions in 12 patients who underwent CAS between March 2015 and May 2015. Patient ages ranged from 54 to 97 years (average: 74.9 years). Ten patients were male, and 7 lesions were symptomatic.<br>Methods: The Mo.Ma Ultra (Mo.Ma) is used as an introducing catheter. Both balloons of the Mo.Ma (the distal balloon in the external carotid and the proximal balloon in the common carotid), are inflated and a tolerance test is performed. If the tolerance test is negative, a PercuSurge GuardWire (PSGW) is advanced to the internal carotid artery (ICA) as a distal embolic protection device. Contrast medium is slowly injected from the Mo.Ma, and the ICA is filled with contrast medium. The PSGW is inflated during this injection, and contrast medium is trapped in the ICA. CAS is performed with reference to the trapped contrast medium.<br>Results: Mo.Ma could be advanced to the target vessel in 8 lesions. One case did not tolerate ICA occlusion and a filter device was substituted. Combined use of Mo.Ma and PSGW was performed in the remaining 7 lesions. Direct road mapping was clinically useful in 5 lesions.<br>Discussion: The image in conventional road mapping is sometimes tilted with straightening of the vessel. This phenomenon occasionally occurs during stent deployment. Direct road mapping solves this problem.<br>Conclusions: Direct road map using Mo.Ma and PSGW is useful during CAS.

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