Cardiac Catheterization Laboratory, Einstein Medical Center, Philadelphia, PA 19141 USA.
J Invasive Cardiol. 2021 Sep;33(9):E723-E729. doi: 10.25270/jic/20.00696.
Carotid artery stenting (CAS) has been associated with increased periprocedural stroke in comparison with carotid endarterectomy (CEA). Three-dimensional (3D) printing of aortic arch and carotid artery may aid with preprocedural planning and adaptive learning, possibly reducing procedure-related complications.
Five CAS cases with available computed tomography angiography (CTA) were retrospectively evaluated and 3D-printed models (3D-PMs) were made. One additional case that was 3D printed preprocedurally provided prospective analysis. Standard 3D printing software was used to create a computer-aided image from CTA series that were 3D printed. The models were painted with acrylic paint to highlight anatomical features. The type of aortic arch, common carotid artery (CCA) to internal carotid artery (ICA) angle, and ICA distal landing zone for embolic protection device (EPD) were analyzed. In addition, stent and EPD sizing was determined preprocedurally for the prospective case. Comparisons of 3D-PM were made with 3D-CTA reconstruction and carotid angiography.
Of 6 cases, 2 had type III and 4 had type I aortic arches. One case, a failed endovascular approach from femoral artery access site requiring reattempt via right brachial artery, had a CCA to ICA angle >60° and a tortuous innominate artery and distal ICA for EPD. The remaining 5 cases had straight distal landing zones for EPD and <60° CCA to ICA angles with successful first endovascular attempt. Additionally, vessel-specific stent and EPD sizing was appropriately chosen for the 1 prospective case.
3D-PM for CAS offers added value compared with CTA by providing improved perceptual and visual understanding of 3D anatomy.
与颈动脉内膜切除术（CEA）相比，颈动脉支架置入术（CAS）会增加围手术期卒中风险。主动脉弓和颈动脉的三维（3D）打印可能有助于术前规划和适应性学习，从而可能降低与手术相关的并发症。
回顾性评估了 5 例有可用计算机断层血管造影（CTA）的 CAS 病例，并制作了 3D 打印模型（3D-PM）。另外 1 例在术前进行了 3D 打印，提供了前瞻性分析。使用标准的 3D 打印软件，从 CTA 系列中创建一个计算机辅助图像，然后进行 3D 打印。模型用丙烯酸漆进行了绘制，以突出解剖特征。分析了主动脉弓类型、颈总动脉（CCA）至颈内动脉（ICA）的夹角，以及用于栓塞保护装置（EPD）的 ICA 远端着陆区。此外，对前瞻性病例进行了术前支架和 EPD 尺寸确定。将 3D-PM 与 3D-CTA 重建和颈动脉造影进行了比较。
在 6 例患者中，2 例为 III 型主动脉弓，4 例为 I 型主动脉弓。1 例因股动脉入路的血管内治疗失败，需要经右肱动脉重新尝试，该患者 CCA 至 ICA 的夹角>60°，无名动脉和 ICA 远端迂曲，需要 EPD。其余 5 例患者 EPD 的远端着陆区为直形，CCA 至 ICA 的夹角<60°，且首次血管内尝试成功。此外，1 例前瞻性病例选择了合适的血管特异性支架和 EPD。
与 CTA 相比，CAS 的 3D-PM 通过提供对 3D 解剖结构的更好的感知和视觉理解，具有附加价值。
