Mitsuhashi Yutaka, Nishio Akimasa, Kawakami Taichiro, Shibamoto Kazunori, Yamagata Tohru, Ichinose Tsutomu, Ohata Kenji
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan.
Neurol Med Chir (Tokyo). 2009 Jul;49(7):320-4. doi: 10.2176/nmc.49.320.
Carotid artery stenting (CAS) is an effective and less invasive alternative to carotid endarterectomy for internal carotid artery (ICA) stenosis, but the guiding catheter is often technically difficult to introduce into the common carotid artery (CCA) in patients with concomitant atherosclerotic disease in the peripheral vessels or aorta. A new pull-through technique between the superficial temporal artery (STA) and the brachial artery was used to deliver the guiding catheter into the CCA safely and steadily. An 83-year-old male presented with repeated transient left hemiparesis caused by severe stenosis of the origin of the right ICA. He also had severe systemic atherosclerotic disease with occlusion of the bilateral femoral arteries. The innominate artery branched at an acute angle from the aorta. Therefore, catheterization of the right CCA seemed to be impossible using a conventional approach. The guidewire introduced from the right STA was lassoed by a loop snare wire and pulled out of the left brachial artery, forming the pull-through system. The guiding catheter could be introduced into the CCA from the left brachial artery over this guidewire. Subsequently, successful stent placement was performed under the distal protection. This new technique may facilitate safe and stable CAS even in patients with a severely tortuous access route due to concomitant atherosclerotic disease.
对于颈内动脉（ICA）狭窄，颈动脉支架置入术（CAS）是一种有效且侵入性较小的替代颈动脉内膜切除术的方法，但对于外周血管或主动脉伴有动脉粥样硬化疾病的患者，导引导管通常在技术上难以插入颈总动脉（CCA）。一种新的颞浅动脉（STA）与肱动脉之间的“拉通”技术被用于将导引导管安全、稳定地插入CCA。一名83岁男性因右侧ICA起始部严重狭窄出现反复短暂性左半身轻瘫。他还患有严重的全身性动脉粥样硬化疾病，双侧股动脉闭塞。无名动脉从主动脉以锐角分支。因此，使用传统方法似乎无法对右侧CCA进行导管插入。从右侧STA引入的导丝被圈套钢丝套住并从左肱动脉拉出，形成“拉通”系统。导引导管可通过该导丝从左肱动脉插入CCA。随后，在远端保护下成功进行了支架置入。即使对于因伴有动脉粥样硬化疾病而具有严重迂曲入路的患者，这种新技术也可能有助于安全、稳定地进行CAS。
