新型长鞘在颈动脉重度狭窄血管内治疗路径建立的初步探讨  

Discussion of endovascular treatment for carotid artery stenosis using a new type of long guide sheath for access establishment

作　　者：郭旭[1] 何晓芬[1] 王力锋[1] 范承哲[1] 张楠[1] 霍晓川 GUO Xu;HE Xiaofen;WANG Lifeng;FAN Chengzhe;ZHANG Nan;HUO Xiaochuan(Department of Cerebral Vascular Disease,Beijing Anzhen Hospital,Capital Medical university,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所脑血管病科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经疾病中心,100029

出　　处：《心肺血管病杂志》2024年第3期281-285,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨新型长鞘在颈动脉狭窄患者血管内治疗路径建立初步使用经验。方法:回顾性连续纳入2022年1月至2023年9月,首都医科大学附属北京安贞医院神经介入科、脑血管病科颈动脉(包括颈总动脉和颈内动脉C1段)重度狭窄(≥70%)患者,使用新型长鞘建立路径,收集一般资料、临床及影像资料等。共30例,颈总动脉狭窄者6例(20.0%),颈内动脉C1段狭窄18例(60.0%),颈总动脉、颈内动脉C1段共同受累者6例(20.0%)。既往同侧颈动脉狭窄伴脑梗死者21例(70.0%),短暂性脑缺血发作者9例(30.0%)。技术成功定义颈总动脉靶血管到位率及颈内动脉支架成形术后前向血流(改良脑梗死溶栓分级)(modified thrombolysis in cerebral infarction score,mTICI,mTICI)3级,且残余狭窄<30%为技术成功;技术失败定位为路径建立失败更改其他介入材料,围手术期并发症定义为术后30d内同侧颈动脉急性缺血性或出血性卒中和全因性死亡。结果:30例患者均患者手术成功。颈动脉支架置入术中1例出现短暂性全面性遗忘;术后随访30d同侧颈动脉脑梗死1例,未出现死亡并发症。结论:新型长鞘在颈动脉路径建立中是安全可行的,可增加迂曲颈总动脉通路导管到位率,减少路径建立过程中血管损伤。Objective:To investigate use of a new generation of long guide sheaths in the endovascular treatment of severe carotid artery stenosis.Methods:From January 2022 to June 2023,A retrospective study was conducted at Beijing Anzhen Hospital,Capital Medical University.The study included patients with severe stenosis of the common carotid artery or segment C1 of the internal carotid artery(≥70%)who were treated in the Department of Neurointerventions and the Department of Cerebrovascular Diseases.A new generation-long guide sheath was used for the procedure,and data on general characteristics,clinical information,and imaging results were collected.Out of the 30 cases included in the study,6 cases(20.0%)had stenosis of the common carotid artery,18 cases(60.0%)had stenosis of the segment C1 of the internal carotid artery,and 6 cases(20.0%)had stenosis of both the common carotid artery and the segment C1 of the internal carotid artery.Among the cases,21(70.0%)had ipsilateral carotid artery stenosis with cerebral infarction,and 9(30.0%)had transient cerebral ischemia.Technical success was defined as achieving target vessel arrival in the common carotid artery and mTICI 3 grade of anterior blood flow after carotid artery stenting,with residual stenosis less than 30%.Technical failure was defined as path establishment failure to change other interventional materials and surgical complications were defined as acute ischemic or hemorrhagic stroke and all-cause death in the ipsilateral carotid artery within 30 days after surgery.Results:Among the 30 patients,all 30(100%)underwent successful surgery.During carotid artery stenting,transient global amnesia was observed in one case,and one case experienced ipsilateral carotid infarction after a 30-day follow-up.Conclusions:The use of the new generation of long guide sheath is both safe and feasible for the endovascular treatment of carotid artery stenosis.This technique can increase the success rate of catheter placement in the tortuous common carotid artery pathway and reduce th

关 键 词：颈动脉狭窄 支架置入术 长鞘 安全性 

分 类 号：R54[医药卫生—心血管疾病]