Santiago-Dieppa David Rafael, Steinberg Jeffrey A, Brandel Michael G, Rennert Robert C, Cheung Vincent J, Wali Arvin Raj, Olson Scott Eric, Khalessi Alexander Arash, Pannell J Scott
Department of Neurological Surgery, University of California, San Diego, California, USA.
Department of Neurological Surgery, University of California, San Diego, California, USA.
World Neurosurg. 2018 May;113:257-260. doi: 10.1016/j.wneu.2018.02.091. Epub 2018 Feb 23.
Crossing a nascently deployed carotid artery stent (CAS) is required to perform angioplasty and filter recapture. If the traversing balloon or filter recapture catheters are eccentric or tangentially angled to the vertical axis of the CAS, they can ensnare on the ledge of the proximal CAS step-off, potentially causing life-threatening complications secondary to deformation, displacement, or mechanical occlusion of the stent. We report a novel "balloon bridge" technique that facilitates safe entry and passage across the CAS with both a balloon catheter and a large-bore guide catheter (LBGC).
We used the balloon bridge technique for 2 patients with >90% carotid artery stenosis and steep carotid artery angles of origin who underwent routine CAS, balloon angioplasty, and distal embolic protection. During filter recapture, the balloon was inflated across the junction of the distal LBGC tip and proximal CAS, centering the LBGC within the vessel lumen and CAS. During balloon deflation, the LBGC was sequentially advanced, successfully navigating the LBGC across the proximal stent construct without resistance or complication.
The balloon bridge technique was completed without complications. We believe that the mechanism of action is secondary to balloon-facilitated LBGC alignment with the true axis of the stent.
Traversing a CAS with an LBGC or balloon catheter can be tedious and fraught with the potential of neurologic peril should mechanical deformation and occlusion occur. The balloon bridge technique is safe and highly effective for navigating a catheter that is eccentric or tangentially angled to the long axis of a CAS.
进行血管成形术和滤网回收时需要穿过新部署的颈动脉支架（CAS）。如果穿过的球囊或滤网回收导管相对于CAS的垂直轴偏心或呈切线角度，它们可能会卡在近端CAS台阶的边缘，可能会因支架变形、移位或机械阻塞而导致危及生命的并发症。我们报告一种新颖的“球囊桥接”技术，该技术可通过球囊导管和大口径引导导管（LBGC）促进安全进入并穿过CAS。
我们对2例颈动脉狭窄>90%且颈动脉起始角度陡峭的患者采用球囊桥接技术，这些患者接受了常规CAS、球囊血管成形术和远端栓子保护。在滤网回收过程中，球囊在远端LBGC尖端与近端CAS的交界处充气，使LBGC在血管腔和CAS内居中。在球囊放气过程中，LBGC依次推进，成功地使LBGC无阻力或并发症地穿过近端支架结构。
球囊桥接技术完成时无并发症。我们认为其作用机制是球囊促进LBGC与支架的真正轴线对齐。
用LBGC或球囊导管穿过CAS可能很繁琐，并且如果发生机械变形和阻塞，存在神经危险的可能性。球囊桥接技术对于引导与CAS长轴偏心或呈切线角度的导管是安全且高效的。
