双导丝并直管交换在人路高度迂曲颈动脉支架植入术中的应用

Application of straight guiding catheter exchange assisted by double guidewire in carotid-artery stenting with circuitous approach

目的研究双导丝合并直型导管交换技术在人路高度迂曲的颈动脉支架植入术中的应用。方法梅州市人民医院神经内二科自2005年8月至2013年1月应用双导丝合并直型导管交换技术行颈动脉支架成形术（CAS）治疗颈内动脉起始部重度狭窄患者15例．分析患者的疗效和并发症的发生情况。比较术前和术后3d、1个月后的美国国立卫生研究院卒中量表评分（NIHSSl情况，以及3个月后改良Rankin量表（mRS）评分情况。结果15例患者中有13例成功植入支架，其中发生颈动脉窦综合征2例，股动脉鞘管周围术后渗血3例，股动脉漏形成1例。1例患者术后NIHSS降低，但头颅CT未见新发脑梗死；与术前[14（9～17）]比较，15例患者术后1月NIHSS评分[11（8-13）]有所降低，差异有统计学意义（z=-10．153，p=-0．000）；患者术后3月mRS评分与术前比较减低，差异有统计学意义（U=2．079，P=-0．045）。结论双导丝合并直管交换技术在入路高度迂曲的颈动脉支架植入术中安全有效。

Objective To explore whether straight guiding catheter exchange assisted by double guidewire can slove the difficult problem of the guiding catheter being unable to enter the right carotid artery in patients with carotid stenosis via circuitous approach. Methods Fifteen patients with severe carotid stenosis, admitted to our hospital from August 2005 to January 2013, were chosen in our study; they were performed straight guiding catheter exchange assisted by double guidewire. Secondary carotid sinus syndrome, puncture wound, acute coronary syndrome, cerebral infarction and cerebral hemorrhage in the postprocedural period were observed; National Institutes of Health Stroke Scale （NIHSS） scores 3 and 30 days after the surgery were recorded and compared; meanwhile, modified Rankin Scale （mRS） scores 3 months after the surgery were compared. Results With the techniques of straight guiding catheter exchange assisted by double guidewire, 13 patients were successfully implanted carotid artery stent among the 15 patients. Two patients had secondary carotid sinus syndrome, 3 had femoral sheath around postoperative bleeding and 1 had femoral artery fistula during the 13 patients. The NIHSS scores in 1 patient decreased after the operation, but new infarction lesion was not found in the head CT. The NIHSS scores 30 days after the surgery [11（8-13）] were significantly lower than the preoperative NIHSS scores [14（9-17）] （Z--10.153, P=-0.000）. The mRS scores 3 months after the surgery was significantly improved as compared with those before surgery （U-2.079, P=-0.045）. Conclusion The application of straight guiding catheter exchange assisted by double guidewire is safe and effective in the carotid-artery stenting via circuitous approach.