Sakamoto Shigeyuki, Kiura Yoshihiro, Okazaki Takahito, Ichinose Nobuhiko, Kurisu Kaoru
Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
J Cerebrovasc Endovasc Neurosurg. 2015 Mar;17(1):27-31. doi: 10.7461/jcen.2015.17.1.27. Epub 2015 Mar 31.
Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.
冠状动脉-锁骨下动脉窃血（CSS）可发生于使用胸廓内动脉（ITA）进行冠状动脉旁路移植术（CABG）之后。ITA移植血管近端的锁骨下动脉（SA）狭窄会导致CSS。我们描述了一种在CABG术后因右SA起始部狭窄导致CSS而行血管内支架置入术时进行心脏和脑保护的技术。一名有使用右ITA进行CABG病史的64岁男性出现劳力性右臂间歇性跛行。血管造影显示由于右SA起始部严重狭窄导致CSS及右椎动脉（VA）逆向血流。计划对右SA狭窄进行血管内治疗。为进行心脏和脑保护，通过右肱动脉途径在右VA和ITA起始部近端的SA中充盈一个5.2F闭塞球囊导管进行远端球囊保护，并通过左股动脉（FA）途径对右颈内动脉（ICA）进行远端滤器保护。在通过ICA滤器保护和VA及ITA球囊保护进行心脏和脑保护的情况下，经右FA途径对SA狭窄进行血管内支架置入术。成功治疗了SA严重狭窄，无并发症发生。
