Mitsui Nobuyuki, Kinoshita Manabu, Nakazawa Junji, Ozaki Hirokazu, Kimura Teruo
Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan.
Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
NMC Case Rep J. 2023 Oct 14;10:279-283. doi: 10.2176/jns-nmc.2023-0146. eCollection 2023.
Endovascular treatment is a standard procedure for subclavian artery stenosis or obstruction. However, great care should be taken to avoid embolic complications to the vertebral artery, and several methods have previously been reported. Hence, as surgical procedures become increasingly complicated, unintended issues may arise during treatment. Here, the authors report a case where the filter-type protection device was caught in the stent because the patient moved during treatment, leading to open surgery to recover the filter-type protection device． A 78-year-old female suffering from a left subclavian steal syndrome underwent stenting due to subclavian artery stenosis. The stenotic lesion was approached via the transfemoral route, and a filter-type protection device was advanced to the vertebral artery via the transbrachial route to prevent embolic complications. As the procedure was performed under local anesthesia, the patient moved during stent deployment proximally to the left vertebral artery origin, and the stent unintentionally advanced distally, covering the vertebral artery and obstructing the retrieval catheter for the filter-type protection device to advance. Failed attempts in recovering the filter-type protection device required open surgery for retrieval. Fortunately, there was no postoperative neurological and radiographic complication, ameliorating her chief complaint． The retriever catheter for the protection device should be advanced beyond the vertebral artery orifice just proximal to the protection device before stenting to avoid such complications while also thoroughly considering the type of anesthesia during treatment．.
血管内治疗是锁骨下动脉狭窄或闭塞的标准治疗方法。然而，应格外小心以避免椎动脉发生栓塞并发症，此前已有多种方法被报道。因此，随着手术操作日益复杂，治疗过程中可能会出现意外问题。在此，作者报告一例病例，由于患者在治疗过程中移动，滤器型保护装置被卡在支架中，导致需进行开放手术以取出滤器型保护装置。一名患有左锁骨下动脉盗血综合征的78岁女性因锁骨下动脉狭窄接受支架置入术。通过经股动脉途径到达狭窄病变部位，并经肱动脉途径将滤器型保护装置推进至椎动脉以预防栓塞并发症。由于手术是在局部麻醉下进行的，在将支架置入左椎动脉起始部近端时患者发生移动，支架意外地向远端推进，覆盖了椎动脉并阻碍了滤器型保护装置的回收导管推进。回收滤器型保护装置的尝试失败，需要进行开放手术取出。幸运的是，术后没有出现神经和影像学并发症，缓解了她的主要症状。在置入支架前，保护装置的回收导管应推进至保护装置近端的椎动脉开口之外，以避免此类并发症，同时在治疗过程中也要充分考虑麻醉类型。
