Ohshima Tomotaka, Miyachi Shigeru, Matsuo Naoki, Kawaguchi Reo, Niwa Aichi, Maejima Ryuya, Isaji Taiki, Takayasu Masakazu
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
J Stroke Cerebrovasc Dis. 2018 Jul;27(7):e144-e147. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.036. Epub 2018 Mar 16.
We report a secure endovascular approach for the treatment of vascular lesions of the posterior circulation. Even if a large profile guide catheter is wedged in the unilateral vertebral artery (VA), our VA flow reversal method can prevent ischemic complications, including the spinal cord infarction.
The patient was a 64-year-old woman who had been followed up for arteriovenous malformation (AVM) and an unruptured aneurysm of the basilar artery-superior cerebellar artery bifurcation. Endovascular treatment was performed because minor bleeding occurred from the AVM. When a 6-French guide catheter was navigated into the right VA, the guide catheter became completely wedged, and blood flow between the tip of the catheter and the VA union was fully stagnated. Because ischemia of the anterior spinal artery and right posterior inferior cerebellar artery could persist for a few hours during the endovascular procedure, we built a continuous reversal circulation from the guiding catheter tip to the femoral vein. The flow stagnation disappeared immediately. There was no complication during embolization of both the AVM and aneurysm.
The VA flow reversal method was secure in this case in which the tip of the guide catheter became wedged in the VA during the endovascular procedure.
我们报告一种用于治疗后循环血管病变的安全血管内治疗方法。即使大口径引导导管楔入单侧椎动脉（VA），我们的椎动脉血流逆转方法也可预防包括脊髓梗死在内的缺血性并发症。
该患者为一名64岁女性，因患有动静脉畸形（AVM）和基底动脉-小脑上动脉分叉处未破裂动脉瘤而接受随访。因AVM出现少量出血而进行血管内治疗。当将一根6F引导导管送入右侧椎动脉时，引导导管完全楔入，导管尖端与椎动脉汇合处之间的血流完全停滞。由于在血管内操作过程中脊髓前动脉和右侧小脑后下动脉的缺血可能会持续数小时，我们建立了从引导导管尖端到股静脉的持续逆向循环。血流停滞立即消失。在对AVM和动脉瘤进行栓塞治疗期间未出现并发症。
在本病例中，血管内操作过程中引导导管尖端楔入椎动脉时，椎动脉血流逆转方法是安全的。
