Diethrich E B, Marx P, Wrasper R, Reid D B
Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix 85006, USA.
J Endovasc Surg. 1996 May;3(2):182-202. doi: 10.1583/1074-6218(1996)003<0182:PTFECI>2.0.CO;2.
To describe the evolving techniques for stent implantation in the proximal and cervical carotid arteries.
Percutaneous access to proximal and cervical carotid lesions is either via direct puncture of the common carotid artery or through the more familiar retrograde common femoral (RCF) artery approach. Both techniques and their variations are described in detail, along with their benefits, disadvantages, and possible complications. Dual lesions at the arch and higher up the neck can be treated either from the RCF route or, if the cervical lesion requires endarterectomy, with open exposure at the bifurcation and stenting of the proximal lesion.
While the RCF route is more familiar to the majority of interventionists and provides adequate access in most situations, traversing the arch and negotiating acute angles at the ostia of the great vessels may render this method infeasible. The direct puncture technique is a useful alternative; however, it requires more expertise to prevent potentially disastrous access-site complications. One further caveat must be stated: regardless of the access approach selected, the opportunity for serious, debilitating-and lethal-complications is always present in cerebrovascular interventions. At this earliest phase in our experience with carotid stenting, cautious investigative methodologies must prevail.
描述颈总动脉近端和颈部颈动脉支架植入技术的发展。
经皮进入颈总动脉近端和颈部病变部位，可通过直接穿刺颈总动脉或更常见的逆行股总动脉（RCF）途径。详细描述了这两种技术及其变体，以及它们的优点、缺点和可能的并发症。主动脉弓和颈部较高位置的双重病变，可通过RCF途径治疗，或者，如果颈部病变需要进行动脉内膜切除术，则可在分叉处进行开放暴露，并对近端病变进行支架植入。
虽然大多数介入医生对RCF途径更为熟悉，且在大多数情况下能提供足够的入路，但穿过主动脉弓并在大血管开口处应对锐角可能使该方法不可行。直接穿刺技术是一种有用的替代方法；然而，它需要更多的专业知识来预防潜在的灾难性入路部位并发症。还必须说明一点：无论选择何种入路方法，脑血管介入治疗中始终存在发生严重、致残甚至致命并发症的可能性。在我们开展颈动脉支架植入术的这一早期阶段，必须采用谨慎的研究方法。
