Cardiovascular Department, S. Donato Hospital, Arezzo, Italy.
J Endovasc Ther. 2012 Jun;19(3):329-38. doi: 10.1583/11-3730MR.1.
To investigate the efficacy and safety of a tailored approach to fit access and engagement techniques to the individual arch anatomy in patients with bovine-type aortic arch (BTAA) to overcome the perceived increased risk of technical failure and cerebral embolization during left internal carotid artery (LICA) stenting.
Thirty-five high surgical risk patients (23 men; mean age 68.6 years, range 62-90) with BTAA and LICA stenosis underwent carotid artery stenting (CAS). Left common carotid artery (LCCA) engagement was achieved by means of different techniques according to the configuration of the BTAA, arch type (I, II, or III), and angle between the innominate artery and the LCCA. The clinical, anatomical, and procedural data were retrieved from a prospectively maintained database and analyzed retrospectively to identify technical modifications required during the procedure compared with planning.
The technical success rate was 100%. Transfemoral access was used in 21 (60%) cases. In this group, the soft engagement technique with hockey stick (HS) guiding catheter and buddy wire in the external carotid artery (ECA) was used in 13 (62%) cases, a simple telescopic technique with 6-F armed introducer or 7-F 40° guiding catheter in 5 (24%) cases, and a sequential technique with a MOMA proximal protection system in the remaining 3 (14%) cases. Among the 14 (40%) right brachial access cases, the telescopic technique with 6-F armed introducer was used in 13 cases. The remaining case was the only one in which the planned technique was changed (from the telescopic to sequential technique with ECA wire exchange). There were no intraprocedural or 30-day neurological events.
An appropriate tailored interventional strategy, planned by means of preprocedural recognition of bovine arch anatomy, is associated with satisfactory safety and good success.
研究一种针对个体主动脉弓解剖结构的定制方法，将其应用于具有牛型主动脉弓（BTAA）的患者的入路和接触技术中，以克服左颈内动脉（LICA）支架置入术中技术失败和脑栓塞风险增加的问题。
35 例高危手术患者（23 例男性；平均年龄 68.6 岁，范围 62-90 岁），具有 BTAA 和 LICA 狭窄，接受颈动脉支架置入术（CAS）。左颈总动脉（LCCA）的入路是根据 BTAA 的形态、弓型（I、II 或 III）和无名动脉与 LCCA 之间的夹角，采用不同的技术来实现。从一个前瞻性维护的数据库中检索到临床、解剖和程序数据，并进行回顾性分析，以确定与计划相比，手术过程中需要进行的技术修改。
技术成功率为 100%。21 例（60%）采用经股动脉入路。在这一组中，13 例（62%）采用 hockey stick（HS）引导导管和外颈动脉（ECA）导丝的软入路技术，5 例（24%）采用 6-F 武装引入器或 7-F 40°引导导管的简单伸缩技术，3 例（14%）采用 MOMA 近端保护系统的序贯技术。在 14 例（40%）右侧肱动脉入路中，13 例采用伸缩技术。其余的 1 例是唯一一例改变计划技术的病例（从伸缩到序贯，经 ECA 导丝交换）。术中或 30 天内无神经事件。
通过术前识别牛型弓解剖结构，制定适当的定制介入策略，与良好的安全性和成功率相关。
