通过双鞘连接技术增加颈动脉血流以减少经颈动脉途径经导管主动脉瓣植入术中的脑缺血。
Increase Carotid Flow by Double Sheath Connection Technique to Reduce Cerebral Ischemia for Transcatheter Aortic Valve Implantation through Transcarotid Approach.
作者信息
Tsai Richard, Chen I-Ming, Chen Po-Lin, Leu Hsin-Bang, Chen Ying-Hwa, Chang Hsiao-Huang
机构信息
Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
Ann Thorac Cardiovasc Surg. 2018 Jun 20;24(3):161-164. doi: 10.5761/atcs.nm.18-00032. Epub 2018 Apr 6.
PURPOSE
Transcarotid transcatheter aortic valve implantation (TAVI) is one alternative approach if unfavorable femoral access. However, this approach may cause cerebral vascular accidents (CVAs) by temporarily occluding common carotid artery (CCA). The purpose of this study is to develop a new method reducing cerebral ischemia during transcarotid TAVI.
METHODS
We inserted an 8- and 18-Fr. sheath in CCA with tip toward brain and aortic arch, respectively, and connected their side arms to create a bypass flow. Medtronic CoreValve was then delivered and deployed in position after pre-TAVI balloon dilatation.
RESULTS
Three patients received this implantation. There were no CVAs or transient ischemic attacks (TIAs) after the procedure and all patients had been followed up uneventfully for 1 year.
CONCLUSION
Our technique is feasible and potentially reduces stroke in transcarotid TAVI.
目的
如果股动脉入路不佳，经颈动脉经导管主动脉瓣植入术（TAVI）是一种替代方法。然而，这种方法可能会因暂时阻断颈总动脉（CCA）而导致脑血管意外（CVA）。本研究的目的是开发一种新方法，以减少经颈动脉TAVI期间的脑缺血。
方法
我们分别在颈总动脉中插入一个8F和一个18F的鞘管，鞘管尖端分别朝向脑部和主动脉弓，并连接它们的侧臂以建立旁路血流。然后在TAVI术前球囊扩张后，输送并将美敦力CoreValve瓣膜定位展开。
结果
三名患者接受了这种植入术。术后没有发生脑血管意外或短暂性脑缺血发作（TIA），所有患者均顺利随访1年。
结论
我们的技术是可行的，并且可能减少经颈动脉TAVI中的卒中发生。
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