Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Division of Vascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Vasc Surg. 2020 Jun;71(6):2012-2020.e18. doi: 10.1016/j.jvs.2019.08.269. Epub 2019 Nov 15.
Endovascular treatment has largely replaced open reconstruction of proximal brachiocephalic and left common carotid ostial arterial stenoses. The objective of this study was to report the technical feasibility and safety of a flow-based embolic protection system in stenting of single and tandem stenotic lesions of supra-aortic arch vessels.
All cases used flow-based neuroprotection by the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, Calif). Case specifics, such as the stents used, the details of flow-based neuroprotection, the order in which lesions were treated, and the case-specific exceptions, are detailed in the body of the publication. The primary end point of this study was the occurrence of stroke or transient ischemic attack.
Sixteen patients (12 women) with an average age of 68 years (range, 54-83 years) underwent endovascular stenting to treat single (11 patients) or tandem (5 patients) stenotic lesions of supra-aortic arch vessels. A total of 21 lesions were treated: 7 in the innominate artery, 1 in the right common carotid artery, 8 in the left common carotid artery, and 5 in the internal carotid artery (tandem cases). Eleven patients (69%) were symptomatic, and the stenoses of the five asymptomatic patients were identified during routine workup for comorbidities. Technical success was obtained in all cases. There were no strokes or transient ischemic attacks during the 30 days after the procedure. Minor complications included a minor wound dehiscence that healed secondarily without sequelae and a hematoma at the neck incision that resolved spontaneously without further intervention.
The use of a transcarotid retrograde approach with flow-based neuroprotection is technically feasible for the endovascular stenting of single and tandem stenotic lesions of the supra-aortic arch vessels. These data further support the advantages of a transcarotid approach and flow-based neuroprotection to minimize the risk of intraoperative complications and embolic events during and after the procedure.
血管内治疗在很大程度上已经取代了近端头臂动脉和左颈总动脉口部狭窄的开放重建。本研究的目的是报告在治疗升主动脉弓血管单发和串联狭窄病变时使用基于血流的栓塞保护系统的技术可行性和安全性。
所有病例均采用 Silk Road Medical（加利福尼亚州森尼韦尔）的 ENROUTE 经颈动脉神经保护系统进行基于血流的神经保护。病例详情，如使用的支架、基于血流的神经保护的细节、治疗病变的顺序以及病例的特殊情况，在文章正文中详细说明。本研究的主要终点是发生卒中和短暂性脑缺血发作。
16 名（12 名女性）平均年龄 68 岁（范围 54-83 岁）的患者接受了血管内支架置入术，以治疗单一（11 例）或串联（5 例）升主动脉弓血管狭窄病变。共治疗了 21 处病变：7 处位于无名动脉，1 处位于右颈总动脉，8 处位于左颈总动脉，5 处位于颈内动脉（串联病变）。11 名患者（69%）有症状，5 名无症状患者的狭窄是在常规检查合并症时发现的。所有病例均获得技术成功。术后 30 天内无卒中或短暂性脑缺血发作。轻微并发症包括轻微的伤口裂开，愈合良好无后遗症；颈部切口血肿自发消退，无需进一步干预。
使用经颈动脉逆行入路联合基于血流的神经保护技术，对治疗升主动脉弓血管单发和串联狭窄病变的血管内支架置入术是可行的。这些数据进一步支持了经颈动脉入路和基于血流的神经保护的优势，可以最大限度地降低术中并发症和术中及术后栓塞事件的风险。
