Department of Neurosurgery, Shinshu University Hospital, Matsumoto, Japan.
Neurointervention Center, Shinshu University Hospital, Matsumoto, Japan.
World Neurosurg. 2019 Nov;131:e362-e370. doi: 10.1016/j.wneu.2019.07.162. Epub 2019 Jul 27.
The benefits of the right transradial approach for anterior circulation lesions using a 6F Simmonds guiding sheath have been reported. However, this technique can be anatomically challenging in the type I aortic arch. Furthermore, to the best of our knowledge, no studies have reported on neurointervention using a Simmonds guiding sheath and the left transradial approach. We devised a novel technique using the contralateral subclavian artery as an "anchor" to reform the Simmonds curve, named the subclavian artery anchoring technique (SCAT). The purpose of the present study was to evaluate the feasibility, safety, and usefulness of neurointervention with the SCAT for patients with a type I aortic arch treated with the right transradial approach and patients treated with the left transradial approach.
Ten consecutive patients treated from June 2018 to January 2019 were included in the present study. We retrospectively analyzed: 1) the success rate for reforming the Simmonds curve using the SCAT; 2) the success rate for introducing the 6F Simmonds guiding sheath into the target common carotid artery; 3) the success rate for completing the procedure; 4) periprocedural complications; and 5) vascular access site complications.
In all 10 patients, the Simmonds curve was reformed, and a 6F Simmonds guiding sheath was introduced into the target common carotid artery. The procedure was successfully achieved for all 10 patients without periprocedural or vascular access site complications.
The results of the present study have shown that this technique is a feasible, safe, and useful method for patients with type I aortic arch treated with a right transradial approach or a left transradial approach. SCAT makes up for a deficiency in the transradial approach with a 6F Simmonds guiding sheath.
使用 6F Simmonds 引导鞘进行右桡动脉入路治疗前循环病变的优势已得到证实。然而，这种技术在 I 型主动脉弓中具有挑战性。此外，据我们所知，尚无使用 Simmonds 引导鞘和左桡动脉入路进行神经介入治疗的研究报告。我们设计了一种使用对侧锁骨下动脉作为“锚”来重塑 Simmonds 曲线的新技术，命名为锁骨下动脉锚定技术（SCAT）。本研究旨在评估使用 SCAT 进行神经介入治疗 I 型主动脉弓患者右桡动脉入路和左桡动脉入路的可行性、安全性和有效性。
本研究纳入了 2018 年 6 月至 2019 年 1 月期间连续治疗的 10 例患者。我们回顾性分析：1）使用 SCAT 重塑 Simmonds 曲线的成功率；2）将 6F Simmonds 引导鞘引入目标颈总动脉的成功率；3）完成手术的成功率；4）围手术期并发症；5）血管入路部位并发症。
在所有 10 例患者中，Simmonds 曲线均得到重塑，6F Simmonds 引导鞘成功引入目标颈总动脉。10 例患者均成功完成手术，无围手术期或血管入路部位并发症。
本研究结果表明，对于右桡动脉入路或左桡动脉入路治疗的 I 型主动脉弓患者，该技术是一种可行、安全、有效的方法。SCAT 弥补了 6F Simmonds 引导鞘经桡动脉入路的不足。
