Transradial approach for stenting of vertebrobasilar stenosis: a feasibility study.
Transradial approach for stenting of vertebrobasilar stenosis: a feasibility study.
复制标题
经桡动脉入路治疗椎基底动脉狭窄支架置入术：可行性研究。
DOI：
10.1002/ccd.22129
复制
发表时间：
2009
影响因子：
2.3
通讯作者：
Sudhir Shah
中科院分区：
文献类型：
--
作者：
Tejas Patel;Sanjay Shah;H. Malhotra;Rajnikant Radadia;L. Shah;Sudhir Shah
背景
椎基底动脉狭窄的血管内介入治疗是一种相对较新的替代治疗方式，得到很少的研究和病例报告的支持。已全部采用股骨入路。本研究的目的是评估桡动脉作为椎动脉支架置入术（VAS）和基底动脉支架置入术（BAS）的替代方法的可行性。
方法
47 名患者（平均年龄 70 +/- 5 岁，38 名男性）接受了 VAS 和 BAS。 42 名患者接受了 VAS，5 名患者接受了 BAS。所有患者均出现狭窄程度大于 75% 的症状。采用同侧径向入路，使用 6Fr 乳内动脉 (IMA) 引导导管对目标椎动脉 (VA) 进行插管。将 0.014 英寸软头冠状动脉导丝推进并停放在罪魁祸首狭窄处。使用 2 x 12 mm(2) 或 2.5 x 12 mm(2) PTCA 导管进行预扩张，并使用 8-10 atm 压力对所有慢性病变部署安装有球囊的 2.5 x 13 mm(2) 或 3 x 13 mm(2) 裸金属支架。对于急性闭塞，手术分为两个阶段。在第一阶段，使用 PTCA 导管 (1.5 x 12 mm(2)) 在 4-6 atm 压力下扩张病变，以建立远端血流。 24小时后，患者被带回来，并使用8-10个大气压的压力在肇事病灶处植入支架。该手术是为了防止过度灌注脑损伤而进行的。
结果
VAS 在 42/42 (100%) 患者中取得成功。五分之五 (100%) 的患者中 BAS 取得了成功。然而，3 名患者出现短暂性围手术期中风，6 小时内完全恢复，1 名患者出现脑出血 (ICH)，24 小时后死亡。过度灌注脑损伤是脑出血的原因。
结论
使用经桡动脉方法的 VAS 和 BAS 似乎是安全的、技术上可行且可重复的。与股动脉入路相比，使用同侧经桡动脉入路使用 IMA 引导导管对椎动脉插管的技术难度应使其更加方便。
BACKGROUND
Endovascular intervention of vertebrobasilar stenosis is a relatively new but alternative modality of management, supported by very few studies and case reports. Femoral approach has been used in all. The purpose of present study is to evaluate feasibility of the radial artery as an alternative approach for vertebral artery stenting (VAS) and basilar artery stenting (BAS).
METHODS
Forty-seven patients (mean age 70 +/- 5, 38 male) underwent VAS and BAS. VAS was offered in 42 and BAS was offered in five patients. All the patients were symptomatic having stenosis greater than 75%. The target vertebral artery (VA) was cannulated using a 6Fr Internal Mammary Artery (IMA) guide catheter using ipsilateral radial approach. 0.014'' floppy tip coronary guide wire was advanced and parked across the culprit stenosis. Pre dilation was done using a 2 x 12 mm(2) or a 2.5 x 12 mm(2) PTCA catheter and balloon mounted 2.5 x 13 mm(2) or 3 x 13 mm(2) bare metal stent was deployed using 8-10 atm pressure for all chronic lesions. For acute occlusions, the procedure was divided in two stages. In first stage, the lesion was dilated using PTCA catheter (1.5 x 12 mm(2)) at 4-6 atm pressure just to establish the distal flow. After 24 hr, the patient was brought back and the culprit lesion was stented using 8-10 atm pressure. The procedure was staged to prevent hyperperfusion brain injury.
RESULTS
VAS was successful in 42/42 (100%) patients. BAS was successful in five out of five (100%) patients. However, three patients had transient periprocedural stroke which recovered completely within 6 hr and one patient developed intracerebral hemorrhage (ICH) who died after 24 hr. Hyper perfusion brain injury was the cause for ICH.
CONCLUSION
VAS and BAS using the transradial approach appear to be safe, technically feasible, and reproducible. Technical ease of cannulation of vertebral artery with IMA guide catheter using ipsilateral transradial approach should make it more convenient when compared with femoral approach.
Yukihiko Adachi：“肝细胞膜物质运输的最新进展”Hepatica 20(1)。
DOI：
--
发表时间：
--
期刊：
影响因子：
--
作者：
通讯作者：
--