Styczen Hanna, Behme Daniel, Hesse Amelie Carolina, Psychogios Marios Nikos
Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
Department of Neuroradiology, Clinic of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Neurointervention. 2019 Sep;14(2):131-136. doi: 10.5469/neuroint.2019.00094. Epub 2019 Aug 7.
Mechanical thrombectomy has become the standard of care for acute stroke caused by large vessel occlusion. As more patients are treated endovascularly, the number of older patients with tortuous vessels has risen. In these patients, catheterizing the internal carotid artery via a transfemoral approach can be very difficult or even impossible. Therefore, in selected patients, alternative strategies to the transfemoral approach have to be applied.
We report a case series of six patients undergoing mechanical thrombectomy via a combined transfemoral and transcarotid approach. Puncture of the carotid artery was conducted using roadmap guidance after an unsuccessful transfemoral attempt. Technical aspects and outcomes with this alternative approach were analyzed.
Direct puncture of the carotid artery was achieved in five out of six patients (83%). In three out of six patients (50%), revascularization (modified Thrombolysis in Cerebral Infarction score ≥2b) was restored. No complications related to endovascular therapy were documented. One patient showed good neurological outcome (modified Rankin Scale [mRS] 5 at admission, mRS 1 at discharge).
A combined transfemoral/transcarotid approach can be an alternative vascular access in patients with problematic vessel anatomy.
机械取栓已成为治疗大血管闭塞所致急性卒中的标准治疗方法。随着越来越多的患者接受血管内治疗，血管迂曲的老年患者数量有所增加。在这些患者中，经股动脉途径插入颈内动脉导管可能非常困难甚至无法进行。因此，对于部分患者，必须采用经股动脉途径以外的替代策略。
我们报告了一组6例通过经股动脉和颈动脉联合途径进行机械取栓的病例。在经股动脉穿刺尝试失败后，使用路图引导进行颈动脉穿刺。分析了这种替代方法的技术要点和治疗结果。
6例患者中有5例（83%）成功实现了颈动脉直接穿刺。6例患者中有3例（50%）实现了血管再通（改良脑梗死溶栓评分≥2b）。未记录到与血管内治疗相关的并发症。1例患者神经功能恢复良好（入院时改良Rankin量表[mRS]评分为5分，出院时为1分）。
对于血管解剖结构复杂的患者，经股动脉/颈动脉联合途径可作为一种替代的血管入路。
