Takenobu Yohei, Nomura Noriko, Toyama Mizuha, Sugita Yoshito, Okada Akihiro, Kawauchi Takeshi, Terada Yukinori, Yang Tao, Inoue Manabu, Hashimoto Kenji
Department of Neurology, Osaka Red Cross Hospital, Osaka, Japan.
Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Cerebrovasc Dis Extra. 2025;15(1):56-61. doi: 10.1159/000543398. Epub 2025 Jan 3.
During carotid artery stenting (CAS), safe navigation of the guiding catheter (GC) is essential for the success of procedures. However, in cases where stenosis or floating thrombi are located in the common carotid artery (CCA), especially for proximal lesions, advancing the GC without touching the lesions is often difficult. We describe a preliminary experience of the "no-touch" technique for navigating the GC to the CCA using an inner catheter with a specifically designed shape and stiffness optimized to overcome tortuous anatomy.
We retrospectively reviewed CAS procedures involving the "no-touch" technique for treating stenotic lesions in the CCA. A 4-Fr Newton-shaped stiff catheter was positioned in the CCA. Given its high stiffness and dedicated shape, contact with the lesser curvature of the aortic arch absorbed kickback force. Then, a 6-Fr intermediate catheter and an 8- or 9-Fr balloon GC were coaxially advanced in sequence to the target position without guidewire support, ensuring "no-touch" with the plaques. Patient characteristics, aortic arch type, lesion location, and periprocedural complications were recorded.
The technique was applied to eight procedures (six left-sided lesions) in 7 patients (median age, 76 years; six men) among 53 CAS procedures performed on 49 patients. Lesions were located at the proximal CCA (four procedures) or the carotid bifurcation (four procedures). Three patients had floating thrombi, and four had type III aortic arches. GCs were successfully navigated without touching the lesions in all cases, with no periprocedural complications.
The "no-touch" technique with a Newton-shaped stiff catheter is useful and feasible for navigating the GC in treating stenotic lesions in the CCA, particularly with tortuous anatomy, proximal lesions, and vulnerable plaques.
在颈动脉支架置入术（CAS）中，引导导管（GC）的安全导航对于手术成功至关重要。然而，在颈总动脉（CCA）存在狭窄或漂浮血栓的情况下，尤其是近端病变，在不接触病变的情况下推进GC往往很困难。我们描述了一种使用具有专门设计形状和刚度的内导管将GC导航至CCA的“无接触”技术的初步经验，该内导管经过优化以克服迂曲的解剖结构。
我们回顾性分析了采用“无接触”技术治疗CCA狭窄病变的CAS手术。将一根4F牛顿形硬导管置于CCA中。鉴于其高刚度和专用形状，与主动脉弓小弯的接触吸收了反冲力。然后，在没有导丝支撑的情况下，依次同轴推进一根6F中间导管和一根8F或9F球囊GC至目标位置，确保与斑块“无接触”。记录患者特征、主动脉弓类型、病变位置和围手术期并发症。
在对49例患者进行的53例CAS手术中，该技术应用于7例患者（中位年龄76岁；6例男性）的8例手术（6例左侧病变）。病变位于CCA近端（4例手术）或颈动脉分叉处（4例手术）。3例患者有漂浮血栓，4例有III型主动脉弓。所有病例中GC均成功导航且未接触病变，无围手术期并发症。
采用牛顿形硬导管的“无接触”技术在治疗CCA狭窄病变时，对于导航GC是有用且可行的，尤其是在解剖结构迂曲、近端病变和易损斑块的情况下。
