Oowaki H, Matsuura N, Ishikawa M
Department of Neurosurgery, Kyoto-Katsura Hospital, Corporation of Social Welfare, The Foundation for Social Services in Kyoto, Japan -
Interv Neuroradiol. 2006 Jan 20;12(Suppl 1):221-8. doi: 10.1177/15910199060120S141. Epub 2006 Jun 15.
We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.
我们描述了一例通过圈套器辅助经肱动脉进行腔内支架置入治疗颈内动脉狭窄的病例。一名68岁男性，患有已知的颈动脉、外周血管和冠状动脉疾病，伴1型人类嗜T细胞病毒（HTLV-1）相关脊髓病（HAM），因严重、进行性右颈内动脉狭窄但伴有主-髂动脉闭塞前来进行腔内血管重建术。经股动脉入路因主-髂动脉闭塞而出现并发症。成功尝试了经肱动脉入路，并在圈套器辅助下通过7F穿梭SL引导鞘（库克公司，布卢明顿）成功置入了一枚SMARTer支架（柯惠血管内公司，迈阿密湖，佛罗里达州）。对于股动脉入路有禁忌或复杂的患者，经肱动脉入路正逐渐成为一种越来越可行的支架置入替代途径。随着器械越来越柔韧和小型化，经肱动脉途径将在特定患者群体中越来越频繁地用于颈内和颅内循环的支架置入。
