Kurauchi Yoshinori, Onda Toshiyuki, Takahashi Ken, Inamura Shigeru, Daibou Masahiko, Nonaka Tadashi
Department of Neurology, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan.
Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan.
J Neuroendovasc Ther. 2024;18(8):224-229. doi: 10.5797/jnet.cr.2024-0026. Epub 2024 Jun 5.
Recently, the use of the radial artery approach for neuroendovascular treatment has become more frequent. The main advantage of this approach is that there is a low complication risk. However, in the aforementioned case, the 6F guiding sheath proved difficult to remove from the radial artery.
A 60-year-old female patient presented with an unruptured basilar tip aneurysm, which we treated with coil embolization under general anesthesia. We performed paracentesis on the right radial artery and inserted a 6F Axcelguide. The radial artery is bifurcated at the brachial region. We guided the Axcelguide to the right subclavian artery and filled the aneurysm with a coil. After embolization, we attempted to remove the Axcelguide. However, we encountered extreme resistance, and removal proved difficult. We injected verapamil, isosorbide nitrate, nitroglycerin, and papaverine hydrochloride intra-arterially and subcutaneously into the forearm and then performed a brachial plexus block. Unfortunately, the situation remained unchanged. We attempted to slowly remove the catheter with the vascular mass remaining adhered to it. We transected the radial artery in the middle. We could not achieve hemostasis through manual compression and thus injected -butyl-2-cyanoacrylate intra-arterially. Postoperatively, the patient experienced mild subcutaneous hematoma and pain.
We consider reporting this case valuable because no previous studies have described similar difficulties in removing a 6F guiding sheath from the radial artery.
近年来，桡动脉途径在神经血管内治疗中的应用越来越频繁。该途径的主要优点是并发症风险低。然而，在上述病例中，6F引导鞘从桡动脉中取出困难。
一名60岁女性患者，患有未破裂的基底动脉尖动脉瘤，我们在全身麻醉下对其进行了弹簧圈栓塞治疗。我们对右桡动脉进行了穿刺，并插入了一个6F Axcelguide。桡动脉在臂部区域分叉。我们将Axcelguide引导至右锁骨下动脉，并用弹簧圈填充动脉瘤。栓塞后，我们试图取出Axcelguide。然而，我们遇到了极大的阻力，取出证明很困难。我们通过动脉内和皮下注射维拉帕米、硝酸异山梨酯、硝酸甘油和盐酸罂粟碱到前臂，然后进行臂丛神经阻滞。不幸的是，情况没有改变。我们试图缓慢取出导管，血管团仍附着在导管上。我们在中间横断了桡动脉。我们无法通过手动压迫实现止血，因此通过动脉内注射了丁基-2-氰基丙烯酸酯。术后，患者出现轻度皮下血肿和疼痛。
我们认为报告该病例很有价值，因为之前没有研究描述过从桡动脉中取出6F引导鞘时遇到类似困难的情况。
