Dahm J B, van Buuren F, Hansen C, Becker J, Wolpers H-G
Department of Cardiology-Angiology, Heart and Vascular Center Neu-Bethlehem, Göttingen, Germany.
Vasa. 2011 Nov;40(6):468-73. doi: 10.1024/0301-1526/a000150.
Carotid artery stenting (CAS) from the femoral approach can be anatomically very difficult and the incidence of complications is higher in patients with anatomical variations of the aortic arch, difficulties related to peripheral vascular disease and/or with access site complications. Because the typical morphology in patients with a bovine- or type-III aortic arch applies for an arterial access from the right upper extremity (e.g. radial, brachial) we evaluated success rates and safety of the right transradial access in a prospective study.
Between June 2009 and October 2010, seventeen patients (mean age 74,4 ± 9 years, 10 male) with a bovine- (n = 4) or type-III aortic arch (n = 12) underwent CAS with a planned transradial- (n = 3) or after problematic transfemoral access (n = 14). In patients with a type-III aortic arch (n = 13), the right target common carotid artery (CCA) was cannulated from the right radial artery with a 5F IMA diagnostic catheter-, in patients with a bovine aortic arch (n = 4), the left CCA was accessed from the right radial artery with a 5F Amplatz- or Judkins left catheter. In all patients a 6F- (n = 14) or 5F- (n = 3) shuttle sheath was inserted via the diagnostic catheter and a 0.035 extra-stiff guidewire. All interventions were carried out with the use of a peripheral embolization protection device (EPD). Primary study endpoints were procedural success and major adverse cardiac and cerebrovascular events (MACCE), secondary endpoints were access site complications and the mean intervention time.
Procedural success could be achieved in all patients (100 %), MACCE and access site complications did not occur in any patient. Mean interventional time was 48 ± 18 min.
CAS using the right transradial approach for left CAS in bovine-type aortic arch or the right transradial approach in type-III aortic arch for right CAS appears to be safe and technically feasible.
经股动脉途径进行颈动脉支架置入术（CAS）在解剖结构上可能非常困难，对于主动脉弓存在解剖变异、患有周围血管疾病和/或存在穿刺部位并发症的患者，并发症发生率更高。由于牛型或III型主动脉弓患者的典型形态适合从右上肢（如桡动脉、肱动脉）进行动脉穿刺，我们在一项前瞻性研究中评估了经右桡动脉穿刺的成功率和安全性。
2009年6月至2010年10月期间，17例患者（平均年龄74.4±9岁，10例男性），其中牛型主动脉弓（n = 4）或III型主动脉弓（n = 12）患者接受了CAS，计划采用经桡动脉途径（n = 3）或在经股动脉穿刺出现问题后（n = 14）。对于III型主动脉弓患者（n = 13），使用5F IMA诊断导管从右桡动脉穿刺右侧目标颈总动脉（CCA）；对于牛型主动脉弓患者（n = 4），使用5F Amplatz或Judkins左导管从右桡动脉穿刺左侧CCA。所有患者均通过诊断导管和0.035英寸超硬导丝插入6F（n = 14）或5F（n = 3）穿梭鞘。所有干预均使用外周栓塞保护装置（EPD）进行。主要研究终点是手术成功率和主要不良心脑血管事件（MACCE），次要终点是穿刺部位并发症和平均干预时间。
所有患者均实现了手术成功（100%），无患者发生MACCE和穿刺部位并发症。平均干预时间为48±18分钟。
在牛型主动脉弓患者中使用经右桡动脉途径进行左CAS，或在III型主动脉弓患者中使用经右桡动脉途径进行右CAS似乎是安全且技术可行的。
