Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Oper Neurosurg (Hagerstown). 2022 Sep 1;23(3):250-253. doi: 10.1227/ons.0000000000000295. Epub 2022 Jul 11.
The large size of guide catheters in the traditional triaxial configuration can prove limiting during transradial vertebrobasilar thrombectomy. This is especially important for the direct aspiration technique because of the large aspiration catheters that can reach an inner diameter of 0.072 in. A strategy that strikes a balance between stable proximal vessel support and distal navigation for aspiration is conceptually attractive.
To describe a series of transradial posterior circulation thrombectomy procedures in which the aspiration catheter served a dual role of guide support and clot aspiration in a coaxial configuration, thus obviating a larger guide catheter.
Patients selected in the series underwent radial artery access and direct over-the-wire navigation of the aspiration catheter into the vertebral artery. With coaxial microcatheter navigation, the aspiration catheter reached distal enough to ingest the clot successfully. Along with clinical and angiographic data, imaging features such as angle of vertebral artery origin were calculated.
Five patients underwent a stand-alone aspiration catheter technique for basilar artery occlusion through transradial access. All procedures resulted in thrombolysis in cerebral infarction 3 recanalization. The mean time to basilar artery recanalization was 10 minutes. No access site complications or vertebral artery dissection were noted. The mean subclavian artery-vertebral origin angle was 84.06° (range 78.2-90.2°).
For patients selected properly based on vascular anatomy and a careful technique, a large bore aspiration catheter can fulfil a stand-alone dual-role, thus obviating the need for a guide catheter. This can potentially improve the technical feasibility and success of transradial vertebrobasilar thrombectomy.
传统三轴构型中的导引导管尺寸较大，在经桡动脉椎动脉基底动脉血栓切除术时可能会受到限制。对于直接抽吸技术来说，这一点尤为重要，因为大的抽吸导管内径可达 0.072 英寸。一种在稳定的近端血管支持和抽吸的远端导航之间取得平衡的策略在概念上是有吸引力的。
描述一系列经桡动脉后循环血栓切除术，其中抽吸导管在同轴构型中同时起到导引导管支撑和血栓抽吸的双重作用，从而避免了更大的导引导管。
该系列中的患者接受桡动脉入路，并直接用抽吸导管进行经钢丝导航进入椎动脉。随着同轴微导管导航，抽吸导管到达足够远的远端，成功摄入血栓。除了临床和血管造影数据外，还计算了椎动脉起源角度等影像学特征。
5 例基底动脉闭塞患者经桡动脉入路采用单纯抽吸导管技术。所有手术均导致血栓溶解，脑梗死 3 级再通。基底动脉再通的平均时间为 10 分钟。未出现入路部位并发症或椎动脉夹层。锁骨下动脉-椎动脉起始角的平均值为 84.06°（范围为 78.2-90.2°）。
对于根据血管解剖结构和仔细的技术选择的合适患者，大口径抽吸导管可以单独发挥双重作用，从而避免使用导引导管。这可能会提高经桡动脉椎动脉基底动脉血栓切除术的技术可行性和成功率。
