Eckard D A, O'Boynick P L, Han P P
Department of Radiology, University of Kansas Medical Center, Kansas City 66160-7234, USA.
J Endovasc Surg. 1996 Nov;3(4):423-8. doi: 10.1583/1074-6218(1996)003<0423:TSSTRI>2.0.CO;2.
Unintentional intracerebral embolization is a serious, ever present threat during neurointerventional procedures. We have devised a method to reduce this intraprocedural risk in vertebral artery interventions by creating a temporary subclavian steal.
For this technique, a temporary balloon occlusion catheter is advanced into the proximal subclavian artery via a femoral artery approach, while a second introducer catheter is passed into the target vertebral artery via an axillary artery access. The temporary occluding balloon is then inflated within the proximal subclavian artery, establishing a subclavian steal that diverts blood flow into the arm. Permanent balloon occlusion of the vertebral artery can then be accomplished without fear of intracerebral embolization. Two patients with vertebrobasilar junction aneurysms were successfully treated with detachable balloon embolization using this cerebral protection technique. The permanent occlusion balloons were easily passed through the introducer catheter without difficulty despite reversed vertebral artery flow. No complications were encountered, and the aneurysms were successfully occluded in both patients.
Temporary subclavian steal can be easily created to reduce the risk of cerebral embolic complications when performing interventional neuroradiological procedures in the vertebral artery.
在神经介入手术过程中，意外的脑内栓塞是一种严重且始终存在的威胁。我们设计了一种方法，通过制造暂时性锁骨下动脉窃血来降低椎动脉介入手术中的这种术中风险。
对于该技术，通过股动脉途径将一根暂时性球囊闭塞导管推进至锁骨下动脉近端，同时通过腋动脉通路将另一根导入导管插入目标椎动脉。然后在锁骨下动脉近端充盈暂时性闭塞球囊，形成锁骨下动脉窃血，使血流转向手臂。这样就可以在不用担心脑内栓塞的情况下完成椎动脉的永久性球囊闭塞。两名椎基底动脉交界区动脉瘤患者使用这种脑保护技术通过可脱性球囊栓塞成功治疗。尽管椎动脉血流逆向，永久性闭塞球囊仍轻松地通过导入导管，未遇到困难。未出现并发症，两名患者的动脉瘤均成功闭塞。
在椎动脉进行介入神经放射学手术时，可轻松制造暂时性锁骨下动脉窃血以降低脑栓塞并发症的风险。
