Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome.
Combined Transradial and Transfemoral Approach With Ostial Vertebral Balloon Protection for the Treatment of Patients With Subclavian Steal Syndrome.
复制标题
DOI：
10.3389/fneur.2020.576383
复制
发表时间：
2020
影响因子：
3.4
通讯作者：
Ortega-Gutierrez S
中科院分区：
文献类型：
--
作者：
Fakih R;Dandapat S;Mendez-Ruiz A;Mendez AA;Farooqui M;Zevallos C;Quispe Orozco D;Hasan D;Rossen J;Samaniego EA;Derdeyn C;Ortega-Gutierrez S
背景资料：患有阻塞性锁骨下动脉（SA）的患者可能表现出椎基底动脉供血不足的症状，称为锁骨下动脉盗血综合征（SSS）。与开放手术相比，支架辅助经皮腔内血管成形术（SAPTA）的血管内治疗显示出术中和术后并发症的百分比显著降低。在SAPTA期间，通过同侧椎动脉（VA）发生远端颅内栓塞的风险为1-5%。目的：旨在评估一种新型远端栓塞保护技术的安全性和可行性，该技术在采用经股动脉和经桡动脉双重入路的SA血运重建期间使用球囊导管进行远端栓塞保护。研究方法：我们描述了一个SSS患者的病例系列，这些患者因SA严重狭窄或闭塞而采用顺行/逆行联合入路接受了SAPTA。使用大口径导引鞘获得经股动脉进入SA。使用中间孔导管获得同侧经桡动脉入路。在SAPTA过程中，通过经桡动脉中间导管将Scepter XC球囊导管导入同侧VA开口处，以进行远端栓塞保护。结果：8例SSS患者接受了锁骨下动脉SAPTA。4例患者采用顺行/逆行联合入路。其中3例血运重建成功。由于严重钙化斑块负荷，在第4例不成功病例中难以创建通道。未发现围手术期缺血事件。在随访中，我们证实了支架的通畅性，症状消退，无任何不良事件。结论：在椎动脉口使用顺应性球囊导管联合经桡动脉和经股动脉入路进行锁骨下支架植入术，以预防远端栓塞，可能是治疗SA狭窄和闭塞的替代治疗方法。
Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1–5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA. Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access. Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection. Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events. Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.
登录
查看更多内容
影响因子：
2.6
作者：
Siewiorek, Gail M.;Wholey, Mark H.;Finol, Ender A.
通讯作者：
Finol, Ender A.
影响因子：
4.3
作者：
de Vries, JPPM;Jager, LC;Moll, FL
通讯作者：
Moll, FL
影响因子：
168.9
作者：
Jolly, Sanjit S.;Yusuf, Salim;Mehta, Shamir R.
通讯作者：
Mehta, Shamir R.
影响因子：
2.9
作者：
Babic, Srdjan;Sagic, Dragan;Vucurevic, Goran
通讯作者：
Vucurevic, Goran
影响因子：
2.3
作者：
Michael, Tesfaldet T.;Banerjee, Subhash;Brilakis, Emmanouil
通讯作者：
Brilakis, Emmanouil