Lee Jong Young, Park Jong-Hwa, Jeon Hong Jun, Yoon Dae Young, Park Seoung Woo, Cho Byung Moon
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea.
Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea.
Neuroradiology. 2018 May;60(5):565-573. doi: 10.1007/s00234-018-1994-4. Epub 2018 Mar 1.
A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice.
From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF).
All patients were elderly (mean age, 78.1 years). The main cause was severe tortuosity of the supra-aortic course or the supra-aortic and infra-aortic courses (eight and five cases, respectively), orifice disturbance (three cases), and femoral occlusion (one case). Through neck dissection, 6-8Fr guiding catheters were placed via subcutaneous tunneling to enhance device stability and support. All cerebral aneurysms were embolized (eight complete and three neck remnants) using the combination of several additional devices. Mechanical stent retrieval with an 8Fr balloon guiding catheter was successfully achieved in a few runs (mean, 2 times; range, 1-3) within the proper time window (mean skin to puncture, 17 ± 4 min; puncture to recanalization, 25 ± 4 min). Each stent was satisfactorily deployed in the proximal ICA and direct CCF without catheter kick-back. All puncture sites were closed through direct suturing without complications.
In the hybrid angiosuite, transcervical access via direct neck exposure is feasible in terms of device profile and support when the femoral route has an unfavorable anatomy.
股动脉途径用于神经介入治疗时，其复杂的走行可能会妨碍到达目标部位。因此，我们确定在杂交血管造影室经颈入路在实际操作中是否适用且有益。
2014年1月至2017年3月，在453例患者中的17例（3.75%）采用了这种方法：11例脑动脉瘤（4例破裂，7例未破裂），4例大脑大动脉急性闭塞，1例颈内动脉近端狭窄，1例直接型颈内动脉海绵窦瘘（CCF）。
所有患者均为老年人（平均年龄78.1岁）。主要原因是主动脉弓以上走行或主动脉弓以上及以下走行严重迂曲（分别为8例和5例）、开口异常（3例）以及股动脉闭塞（1例）。通过颈部解剖，经皮下隧道置入6-8Fr引导导管，以增强器械稳定性和支撑力。所有脑动脉瘤均使用多种额外器械联合进行栓塞（8例完全栓塞，3例瘤颈残留）。在合适的时间窗内（平均皮肤穿刺时间17±4分钟；穿刺至再通时间25±4分钟），使用8Fr球囊引导导管进行机械取栓，几次操作即成功完成（平均2次；范围1-3次）。每个支架均满意地植入颈内动脉近端和直接型CCF，未出现导管反弹。所有穿刺部位均通过直接缝合关闭，无并发症发生。
在杂交血管造影室，当股动脉途径解剖结构不利时，经颈部直接暴露的经颈入路在器械外形和支撑方面是可行的。
