Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
World Neurosurg. 2024 Mar;183:e920-e927. doi: 10.1016/j.wneu.2024.01.058. Epub 2024 Jan 17.
Transcarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a trans-distal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit.
Six internal carotid artery stenosis patients underwent CAS using "the forearm flow reversal technique." Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein.
Successful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases.
Trans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.
经颈动脉血管重建术（TCAR）已成为一种替代颈动脉血管成形术（CAS）的方法。TCAR 通过避免股动脉穿刺和建立近端保护而无需穿过狭窄病变，证明了其优越性。在 TCAR 时代，我们专注于经远端桡动脉途径（DRA）的可能性。通过 DRA 引导球囊引导导管在病变穿过之前建立近端保护。前臂皮下静脉用作血流逆转回路。
6 例颈内动脉狭窄患者接受了“前臂血流逆转技术”的 CAS。每个手术均在持续从颈总动脉到前臂头静脉的血流逆行下进行。
所有患者均成功实现了血运重建，没有出现缺血或入路并发症。所有病例在出院时，远端桡动脉均通畅。
经远端桡动脉 CAS 联合前臂血流逆转是一种可行的、微创性更强的技术选择。
