Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Endovasc Ther. 2010 Oct;17(5):652-6. doi: 10.1583/10-3156.1.
To describe a 2-wire technique for innominate artery stent placement under embolic protection.
Confronted with a high-grade innominate artery stenosis that blocked passage of a 0.035-inch stent delivery system from the femoral approach, a 0.018-inch guidewire was advanced in retrograde fashion via the right radial artery and captured via the femoral approach, establishing right radial–femoral through-and-through access. The 0.018-inch guidewire provided excellent support for positioning an 8-F hydrophilic sheath at the origin of the innominate artery. A 0.035-inch catheter was used to cross the lesion from the femoral approach, and a 0.014-inch buddy wire was introduced into the right common carotid artery. A 7-mm SpideRX filter was then deployed over the 0.014-inch guidewire. The 2-wire combination was used to load a 0.035-inch–compatible balloon-expandable stent system, which was deployed in the innominate artery and flared proximally, with excellent angiographic result.
This technique provided excellent support in difficult anatomy while enabling use of a 0.035-inch–compatible stent and embolic protection. It has also been applied in the subclavian artery with protection of the vertebral or internal mammary artery and for lower extremity interventions.
描述一种在栓塞保护下进行无名动脉支架置入的双导丝技术。
在遇到高位无名动脉狭窄，0.035 英寸支架输送系统无法从股动脉入路通过时，我们经右桡动脉逆行推进 0.018 英寸导丝，并通过股动脉入路捕获该导丝，从而建立右桡动脉-股动脉直通通路。0.018 英寸导丝为在无名动脉起始处定位 8F 亲水鞘提供了极好的支持。使用 0.035 英寸导管从股动脉入路穿过病变，同时将 0.014 英寸的导丝引入右颈总动脉。然后在 0.014 英寸导丝上部署一个 7 毫米的 SpideRX 滤器。然后使用双导丝组合装载 0.035 英寸兼容的球囊扩张支架系统，该系统在无名动脉内扩张并向近端扩张，造影结果良好。
这种技术在困难的解剖结构中提供了极好的支持，同时能够使用 0.035 英寸兼容的支架和栓塞保护装置。它也已经应用于锁骨下动脉，以保护椎动脉或内乳动脉，并用于下肢介入治疗。
