Miyata Takeshi, Hatano Taketo, Ogura Takenori, Agawa Yuji, Nakazawa Yusuke
Neurosurgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Neurology, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2024 Sep 28;16(9):e70410. doi: 10.7759/cureus.70410. eCollection 2024 Sep.
Carotid artery stenting (CAS) has been established as an effective surgical treatment for internal carotid artery stenosis and/or common carotid artery stenosis (ICAS/CCAS). Typically, CAS is performed via a transfemoral, transbrachial, or transradial approach. However, direct puncture CAS (DP-CAS) is preferred in cases where conventional access routes are challenging, such as in the presence of cervical vascular tortuosity or thoracic aortic aneurysm. Since 2020, our institution has selectively adopted DP-CAS, utilizing 3D exoscopy through the ZEISS KINEVO 900 microscope (Carl Zeiss AG, Oberkochen, Germany) or the ORBEYE exoscope (Sony Olympus Medical Solutions Inc., Tokyo, Japan) for carotid artery surgical exposure and puncture under high magnification in a hybrid operating room. In the hybrid operating room, exoscopic and angiographic fluoroscopic monitors were positioned side by side, enabling the surgeon to simultaneously visualize both during the puncture procedure. In cases utilizing the ORBEYE exoscope, its compact design minimized interference with the fluoroscopic arm, thereby facilitating improved working angles during CAS. This technical report reveals the current status of DP-CAS at our institution and focuses on the effectiveness of DP-CAS using an exoscope based on our clinical experience.
颈动脉支架置入术（CAS）已被确立为治疗颈内动脉狭窄和/或颈总动脉狭窄（ICAS/CCAS）的一种有效手术方法。通常情况下，CAS通过经股动脉、经肱动脉或经桡动脉途径进行。然而，在传统入路具有挑战性的情况下，如存在颈部血管迂曲或胸主动脉瘤时，直接穿刺CAS（DP-CAS）是首选方法。自2020年以来，我们机构选择性地采用了DP-CAS，在杂交手术室中，通过蔡司KINEVO 900显微镜（德国奥伯科亨卡尔蔡司公司）或ORBEYE电子内镜（日本东京索尼奥林巴斯医疗解决方案公司）利用3D电子内镜在高倍放大下进行颈动脉手术暴露和穿刺。在杂交手术室中，电子内镜和血管造影荧光透视监视器并排摆放，使外科医生在穿刺过程中能够同时看到两者。在使用ORBEYE电子内镜的病例中，其紧凑的设计最大限度地减少了对荧光透视臂的干扰，从而在CAS过程中便于获得更好的工作角度。本技术报告揭示了我们机构DP-CAS的现状，并根据我们的临床经验重点介绍了使用电子内镜的DP-CAS的有效性。
