Gao Bu-Lang, Xu Gang-Qin, Wang Zi-Liang, Li Tian-Xiao, Wang Yong-Feng, Liang Xiao-Dong, Yang Bo-Wen
Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
World Neurosurg. 2018 Mar;111:e661-e667. doi: 10.1016/j.wneu.2017.12.138. Epub 2017 Dec 30.
The effects and safety of transradial access for stenting of carotid artery stenosis in patients with bovine-type and type III aortic arch are currently unknown and are the purpose of this study.
Patients who were treated with stenting via transradial (n = 28) compared with transfemoral (n = 30) access of carotid artery stenosis complicated with bovine-type and type III aortic arch were enrolled. The clinical data were studied for comparison.
The success rate of transradial access for carotid artery stenting was 100%. During the transradial access procedure, 3 patients experienced a temporary blood pressure drop and bradycardia that was resolved with atropine injection. No radial artery occlusion or severe cardiac or cerebral events occurred. The success rate of transfemoral access for carotid artery stenting was 90% with failure in 3 patients. No complications occurred during or after the stenting procedure. The irradiation duration was significantly (P = 0.001) smaller in transradial than in transfemoral access stenting (8.6 ± 0.87 vs. 11.4 ± 1.25 minutes). The arterial stenosis ranged 71.25%-96.50% (mean, 86.50% ± 10.15%) for transradial and 78%-97.75% (85.1% ± 10.42%) for transfemoral access groups before treatment, and the residual stenosis following treatment was significantly smaller in either the transradial (2.4%-17.75%; mean, 11.2% ± 6.03%) or transfemoral (4%-18.6%; mean, 12.4% ± 6.3%) groups compared with before treatment, respectively.
The transradial access for stenting of patients with type III aortic arch plus left carotid artery stenosis or in the bovine-type aortic arch combined with right carotid artery stenosis can decrease the stenting difficulty, risks of embolization, and radiation time and increase the success rate.
目前，牛型和III型主动脉弓患者经桡动脉途径行颈动脉狭窄支架置入术的效果及安全性尚不清楚，本研究旨在探讨这一问题。
纳入经桡动脉途径（n = 28）与经股动脉途径（n = 30）行颈动脉狭窄支架置入术且合并牛型和III型主动脉弓的患者，对临床资料进行比较研究。
经桡动脉途径行颈动脉支架置入术的成功率为100%。在经桡动脉途径操作过程中，3例患者出现暂时性血压下降和心动过缓，经注射阿托品后缓解。未发生桡动脉闭塞或严重的心脑血管事件。经股动脉途径行颈动脉支架置入术的成功率为90%，3例患者失败。支架置入过程中及术后均未发生并发症。经桡动脉途径支架置入术的照射时间显著短于经股动脉途径（P = 0.001）（8.6±0.87分钟 vs. 11.4±1.25分钟）。治疗前，经桡动脉途径组的动脉狭窄范围为71.25% - 96.50%（平均86.50%±10.15%），经股动脉途径组为78% - 97.75%（85.1%±10.42%）；治疗后，经桡动脉途径组（2.4% - 17.75%；平均11.2%±6.03%）和经股动脉途径组（4% - 18.6%；平均12.4%±6.3%）的残余狭窄均较治疗前显著减小。
III型主动脉弓合并左颈动脉狭窄或牛型主动脉弓合并右颈动脉狭窄患者经桡动脉途径行支架置入术可降低支架置入难度、栓塞风险和放射时间，并提高成功率。
