Ando Kazuhiro, Kikuchi Bumpei, Watanabe Jun, Takino Toru, Mouri Yoshihiro, Watabe Yuki, Shida Kazuki, Yamashita Shinya
Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.oa.2024-0108. Epub 2025 Apr 23.
Insertion of a guiding catheter (GC) system into the desired arterial site is crucial in mechanical thrombectomy (MT). This study assessed the factors of difficult GC access to the target carotid artery in patients with acute ischemic stroke in the anterior circulation.
In total, 174 patients who had undergone MT were retrospectively reviewed. The incidence of patients who could not undergo GC insertion to the target carotid artery, as well as the characteristics and outcomes of patients requiring a longer groin puncture-to-GC insertion time, were examined. The patients were divided into 3 groups based on the time from groin puncture to insertion into the target carotid artery: group A, within 10 min; group B, within 10-20 min; and group C, >20 min. In this study, the transfemoral catheter access was the primary option, and the approach site was changed based on the operator's discretion. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction grade ≥2B. A favorable outcome was defined as a modified Rankin Scale score of 0-2.
Catheterization of the target carotid artery could not be performed in 8 (4.6%) patients, who were older and more likely to be female. The proportion of patients with a height ≤150 cm and the percentage of patients with a type III arch and/or tortuous common carotid artery (CCA) were high. The approach was changed in 4 (2.3%) patients, and GC insertion was successful in all cases. A significant difference was observed among the 3 groups in terms of age and the percentage of patients with a type III arch and/or CCA tortuosity and internal carotid artery occlusion. In addition, the time from groin puncture to recanalization significantly differed. The recanalization rate and the 90-day favorable outcome rate were significantly lower in patients with a groin puncture-to-GC insertion time >20 min.
We need to make an effort to insert the GC within 20 min while actively considering changes in the approach, particularly in older patients and those with a type III arch and/or tortuous CCA.
在机械取栓术（MT）中，将引导导管（GC）系统插入理想的动脉部位至关重要。本研究评估了前循环急性缺血性脑卒中患者GC进入目标颈动脉困难的相关因素。
对174例行MT的患者进行回顾性分析。检查无法将GC插入目标颈动脉的患者发生率，以及腹股沟穿刺至GC插入时间较长的患者的特征和预后。根据从腹股沟穿刺到插入目标颈动脉的时间将患者分为3组：A组，10分钟内；B组，10 - 20分钟；C组，>20分钟。本研究中，经股动脉导管入路是主要选择，入路部位根据术者判断进行改变。成功再灌注定义为改良脑梗死溶栓分级≥2B级。良好预后定义为改良Rankin量表评分为0 - 2分。
8例（4.6%）患者无法对目标颈动脉进行插管，这些患者年龄较大且女性居多。身高≤150 cm的患者比例以及III型主动脉弓和/或颈总动脉（CCA）迂曲的患者百分比均较高。4例（2.3%）患者改变了入路，所有病例GC插入均成功。3组在年龄、III型主动脉弓和/或CCA迂曲及颈内动脉闭塞患者百分比方面存在显著差异。此外，从腹股沟穿刺到再通的时间也有显著差异。腹股沟穿刺至GC插入时间>20分钟的患者再通率和90天良好预后率显著较低。
我们需要努力在20分钟内插入GC，同时积极考虑改变入路，尤其是在老年患者以及有III型主动脉弓和/或CCA迂曲的患者中。
