Tsutsumi Masanori, Kazekawa Kiyoshi, Onizuka Masanari, Kodama Tomonobu, Nii Kouhei, Aikawa Hiroshi, Iko Minoru, Tomokiyo Makoto, Matsubara Shuko, Tanaka Akira
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
Neurol Med Chir (Tokyo). 2007 Jun;47(6):285-7; discussion 287-8. doi: 10.2176/nmc.47.285.
Carotid artery stenting for carotid bifurcation stenosis usually uses the transfemoral approach. However, in patients with proximal common carotid artery (CCA) stenosis, the guiding catheter is difficult to introduce into the narrow origin of the CCA without risking cerebral embolization before activation of the protection device. A technique of cerebral protection by internal carotid artery (ICA) clamping with or without simultaneous external carotid artery (ECA) clamping was used to treat patients with proximal CCA stenosis by the retrograde direct carotid approach. The carotid bifurcation was surgically exposed and retrograde catheterization was performed to approach the stenosis. The ICA was clamped during angioplasty and stenting to avoid cerebral embolization. The ECA was clamped simultaneously if any extracranial-intracranial anastomosis was present. None of five patients treated with this technique experienced ischemic complications attributable to this technique.
颈动脉支架置入术治疗颈动脉分叉狭窄通常采用经股动脉途径。然而，对于颈总动脉（CCA）近端狭窄的患者，在激活保护装置之前，将引导导管引入狭窄的CCA起始部而不冒脑栓塞风险是困难的。一种通过夹闭颈内动脉（ICA）并可同时夹闭颈外动脉（ECA）进行脑保护的技术，被用于通过逆行直接颈动脉途径治疗CCA近端狭窄的患者。手术暴露颈动脉分叉并进行逆行插管以接近狭窄部位。在血管成形术和支架置入期间夹闭ICA以避免脑栓塞。如果存在任何颅外-颅内吻合，则同时夹闭ECA。采用该技术治疗的5例患者均未发生归因于该技术的缺血性并发症。
