Shibata Teishiki, Oomura Masahiro, Nishikawa Yusuke, Mase Mitsuhito
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Neurointervention. 2020 Mar;15(1):31-36. doi: 10.5469/neuroint.2019.00290. Epub 2020 Feb 7.
In mechanical endovascular thrombectomy (MET) for acute basilar artery occlusion (ABAO) in the elderly, navigating a guide catheter via the femoral artery may be difficult due to the approach route's significant tortuosity. To resolve this problem, we have been performing a technique that uses a direct brachial approach (DiBA) with a large-bore aspiration catheter. We reported our preliminary clinical experience with this technique. MET for ABAO using the DiBA technique was performed on 4 consecutive patients between August 2017 and December 2018. In all patients, thrombolysis in cerebral infarction 2B or 3 recanalization was achieved, but the modified Rankin Scale at 90 days was ≥4. There were no technical difficulties or complications with this technique. The DiBA technique is an effective and feasible approach in MET for ABAO. Although excellent clinical outcomes could not be achieved, the angiographic outcomes were excellent with no technical complications. This approach can be an alternative to the femoral artery approach, particularly for tortuous arteries in the elderly.
在老年急性基底动脉闭塞（ABAO）患者的机械性血管内血栓切除术（MET）中，由于经股动脉途径的显著迂曲，引导导管的置入可能会很困难。为了解决这个问题，我们一直在实施一种使用大口径抽吸导管的直接肱动脉入路（DiBA）技术。我们报告了这项技术的初步临床经验。2017年8月至2018年12月期间，连续4例患者采用DiBA技术进行了ABAO的MET治疗。所有患者均实现了脑梗死2B级或3级再通，但90天时改良Rankin量表评分≥4分。该技术没有技术困难或并发症。DiBA技术在ABAO的MET中是一种有效且可行的方法。虽然未取得优异的临床结果，但血管造影结果良好，且无技术并发症。这种入路可以作为股动脉入路的替代方法，特别是对于老年患者的迂曲动脉。
