Department of Neurosurgery, The 12839Jikei University School of Medicine Tokyo, Tokyo, Japan.
Interv Neuroradiol. 2021 Aug;27(4):503-510. doi: 10.1177/1591019920987345. Epub 2021 Jan 7.
The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients.
From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received dual antiplatelet drugs before the procedure. Eleven patients (21.2%) (12 procedures) were treated with the DCEA. The rest were treated with TFBA. The main indication of the DCEA was an unfavorable aortic arch or vessel tortuosity. Complications and the duration of the procedure were compared between the two groups.
There were no significant differences between the two groups in age, aneurysm location, preoperative antiplatelet use, heparin use, or maximum activated clotting time (ACT) values. All endovascular treatments were successfully performed by DCEA. Among all parameters, the DCEA group had only bigger average aneurysm diameter (14 mm) and higher number of pipeline embolic device (PED) placement (58%). Time to the guiding-catheter placement was not significantly different between the groups (DCEA vs TFBA = 31.0 min vs 24.7 min, p = 0.178). No significant complications of DCEA, such as subcutaneous hematomas, were observed. .
Even with the use of antiplatelet and anticoagulation therapy, the DCEA can be performed safely for unruptured aneurysms in elderly patients.
对于因动脉硬化导致严重血管迂曲的老年患者，直接颈动脉暴露术（DCEA）是一种技术选择。我们评估了与抗血小板/抗凝治疗相关的并发症，并比较了 DCEA 与标准经股/肱动脉入路（TFBA）在治疗老年未破裂颅内动脉瘤中的效果。
2017 年 8 月至 2020 年 8 月，我们机构治疗了 52 例（53 例次）年龄超过 75 岁的前循环未破裂动脉瘤患者。所有患者在术前均接受双联抗血小板药物治疗。11 例（21.2%）（12 例次）患者采用 DCEA 治疗。其余患者采用 TFBA 治疗。DCEA 的主要适应证为主动脉弓或血管迂曲不良。比较了两组患者的并发症和手术时间。
两组患者的年龄、动脉瘤位置、术前抗血小板使用、肝素使用或最大活化凝血时间（ACT）值均无显著差异。所有血管内治疗均成功通过 DCEA 完成。在所有参数中，DCEA 组的平均动脉瘤直径较大（14mm），放置的Pipeline 栓塞装置（PED）数量较多（58%）。两组到达导引导管放置的时间无显著差异（DCEA 组 vs TFBA 组：31.0 分钟 vs 24.7 分钟，p=0.178）。未观察到 DCEA 的明显并发症，如皮下血肿等。
即使在使用抗血小板和抗凝治疗的情况下，DCEA 也可安全用于老年未破裂动脉瘤的治疗。
