Hoh Daniel J, Larsen Donald W, Elder James B, Kim Paul E, Giannotta Steven L, Liu Charles Y
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Neurosurgery. 2008 May;62(5 Suppl 2):ONSE412-3; discussion ONSE413-4. doi: 10.1227/01.neu.0000326027.39467.88.
Several different methodologies for proximal occlusion and retrograde suction decompression of large paraclinoid aneurysms have been reported previously. In this article, we describe the novel use of an endovascular embolectomy device (F.A.S.T. funnel catheter; Genesis Medical Interventional, Inc., Redwood City, CA) for temporary internal carotid artery occlusion and suction decompression of an intracranial aneurysm to facilitate surgical clip ligation. The combination of atraumatic occlusion technology and large lumen size makes this technique safer and easier.
A 53-year-old woman with progressive headaches underwent computed tomographic angiography, which revealed an unruptured large left paraclinoid aneurysm. Cerebral angiography confirmed the diagnosis. The patient did not tolerate a balloon test occlusion for therapeutic Hunterian internal carotid occlusion. The patient was subsequently taken to the operating room for a craniotomy and clip ligation of the aneurysm.
A standard left pterional craniotomy was performed with opening of the sylvian fissure and exposure of the left paraclinoid aneurysm. Intraoperative angiography with introduction of a new endovascular embolectomy device was performed. The device was deployed to achieve temporary occlusion of the cervical internal carotid artery, and aspiration through the central lumen allowed for retrograde suction decompression of the aneurysm. Collapse of the aneurysm through this technique permitted visualization of the aneurysmal neck with successful clip ligation.
A new endovascular embolectomy device can be used to safely perform suction decompression of large paraclinoid aneurysms to facilitate clip ligation.
此前已有多种不同方法用于大型床突旁动脉瘤的近端闭塞和逆行抽吸减压。在本文中，我们描述了血管内取栓装置（F.A.S.T.漏斗导管；创世纪医疗介入公司，加利福尼亚州红木城）在临时闭塞颈内动脉及抽吸颅内动脉瘤减压以促进手术夹闭方面的新应用。无创闭塞技术与大腔径的结合使该技术更安全、简便。
一名53岁进行性头痛女性接受了计算机断层血管造影，显示左侧床突旁有一未破裂大型动脉瘤。脑血管造影确诊。患者不耐受用于治疗性亨特颈内动脉闭塞的球囊试验闭塞。随后患者被送往手术室行开颅手术及动脉瘤夹闭术。
行标准左翼点开颅术，打开外侧裂并暴露左侧床突旁动脉瘤。术中引入新型血管内取栓装置进行血管造影。该装置展开以临时闭塞颈段颈内动脉，通过中央腔进行抽吸可对动脉瘤进行逆行抽吸减压。通过该技术使动脉瘤塌陷，得以显露瘤颈并成功夹闭。
新型血管内取栓装置可安全用于大型床突旁动脉瘤的抽吸减压以促进夹闭。
