路径建立在覆膜支架治疗颈动脉病变中的意义

Important role of guiding road in treatment of carotid artery lesion by covered stent

目的总结覆膜支架治疗颈动脉病变中路径建立的重要意义及合适方法。方法郑州大学人民医院介入中心自2013年1月至2014年10月间使用覆膜支架封堵治疗颈动脉病变患者10例，其中动脉瘤8例，外伤后假性动脉瘤1例，复发性颈动脉海绵窦瘘1例。对颈动脉血管路径平直的5例病变，采用常规的6FEnvoy导引导管建立路径，或直接使用动脉鞘作为导引导管；对血管路径迂曲的4例病变，采用Neuron070导引导管和70cm长加强动脉鞘建立路径：对血管路径迂曲的1例眼动脉段病变，采用常规的6F Envoy导引导管建立路径。路径建立后引入相应的覆膜支架。采用Hunt-Hess评分分别评估手术前、术后即时和术后1周患者得分，评价患者神经功能。结果除了1例血管路径迂曲的眼动脉段动脉瘤患者支架未到位外，其余9例覆膜支架均顺利到达病变。覆膜支架释放后，手术即时治愈率达90％。9例患者术前、术后即时和术后1周Hunt—Hess评分均为0分；支架未到位的1例蛛网膜下腔出血患者术前、术后即时和术后1周Hunt-Hess评分均为1分。结论良好的路径建立是使用覆膜支架成功治疗颈动脉病变的关键。Neuron070导引导管和较长动脉鞘的应用能明显扩展覆膜支架在颈动脉病变中的适用范围。

Objective To summarize the important role of guiding road in treatment of carotid artery lesion by covered stent. Methods From January 2013 to October 2014, the consecutive data were collected from 10 patients with carotid artery lesions treated with covered stents, including 8 of aneurysms, one of traumatic pseudoaneurysm and one of recurrent carotid cavernous fistula. For 5 lesions with straight carotid artery path, the use of conventional 6F Envoy guiding catheter path was established, or the introduce sheath itself was used as guiding catheter; for 4 lesions with tortuous carotid artery path, Neuron070 guiding catheters and 70 cm 7-French reinforced long introduce sheath was used to establish guiding road; for one ophthalmic artery lesion with tortuous carotid artery path, conventional 6F Envoy guiding catheter was used to establish guiding road. The established guiding roads were followed by navigation of covered stent. Hunt-Hess scale was performed to evaluate the neurological functions before operation, immediate post-operation and one week after surgery. Results Except for the guiding road for one of ophthalmic artery aneurysm with tortuous carotid artery path, the remaining covered stents in the 9 patients successfully reached the lesions. All covered stents were successfully deployed in the patent arteries across the lesions, the lesions were cured immediately without contrast agent filling; the cure rate reached 90%. Hunt-Hess scale score was 0 in 9 patients before operation, immediate post-operation and one week after surgery; that was one in one subarachnoid hemorrhage patient. Conclusions A good guiding road is the key to reach the carotid artery lesion for covered stent. Usage of Neuron070 guiding catheter and reinforced long introduce sheaths can significantly extend the scope of application of the covered stent in tortuous carotid artery lesions.