Department of Neurosurgery, Yokohama Brain and Spine Center.
Department of Neurosurgery, Graduate School of Medicine, Yokohama City University.
Neurol Med Chir (Tokyo). 2023 Jul 15;63(7):321-326. doi: 10.2176/jns-nmc.2022-0397. Epub 2023 Apr 6.
Common carotid artery (CCA) occlusion (CCAO) is a rare cause of ischemic stroke and bypass surgery is the common treatment approach. However, safer alternatives should be developed to treat CCAO. A 68-year-old male was diagnosed with left-sided CCAO with decreased left visual acuity due to neck radiation therapy for laryngeal cancer. Recanalization therapy using a pull-through technique was initiated because cerebral blood flow progressively decreased during the follow-up period. First, after a short sheath was inserted into the CCA, the occluded CCA was retrogradely penetrated through the sheath. Second, a micro-guidewire was guided to the aorta from the femoral sheath where it was caught using a snare wire guided from the cervical sheath. Subsequently, the micro-guidewire was gently pulled out from the cervical sheath, penetrated the occluded lesion, and was secured to the femoral and cervical sheaths. Finally, the occluded lesion was dilated using a balloon, and the stent was placed. Five days postprocedure, the patient was discharged uneventfully and exhibited improved left visual acuity. In terms of reliable penetration of obstructive lesions and reduction of embolic and hemorrhagic complications, combined endovascular antegrade and direct retrograde carotid artery stenting is a versatile and minimally invasive treatment option for CCAO.
颈总动脉闭塞（CCAO）是缺血性脑卒中的罕见病因，旁路手术是常见的治疗方法。然而，应该开发更安全的替代方法来治疗 CCAO。一名 68 岁男性因喉癌颈部放疗而被诊断为左侧 CCAO，并伴有左侧视力下降。由于在随访期间脑血流逐渐减少，因此开始采用经皮抽吸技术进行再通治疗。首先，在将短鞘插入 CCA 后，通过鞘逆行穿透闭塞的 CCA。其次，将微导丝从股鞘引导至主动脉，然后使用从颈鞘引导的套圈线捕获微导丝。随后，将微导丝轻轻从颈鞘中拉出，穿透闭塞病变，并固定在股鞘和颈鞘上。最后，使用球囊扩张闭塞病变，并放置支架。术后 5 天，患者顺利出院，左侧视力有所改善。在可靠穿透阻塞性病变和减少栓塞和出血性并发症方面，联合血管内顺行和直接逆行颈动脉支架置入术是 CCAO 的一种多功能、微创治疗选择。
