经右侧桡动脉入路支架成形术治疗牛角型或Ⅲ型主动脉弓合并颈动脉狭窄

Treatment of bovine type and type Ⅲ aortic arch carotid stenosis with stent angioplasty via the right radial approach

目的 探讨经右侧桡动脉入路支架成形术治疗牛角型主动脉弓或Ⅲ型主动脉弓合并颈动脉狭窄的可行性及安全性.方法 回顾性分析2015年9月至2016年2月郑州大学人民医院脑血管介入治疗中心经右侧桡动脉入路支架成形术治疗的16例Ⅲ型主动脉弓合并右侧颈动脉狭窄或牛角型主动脉弓合并左侧颈动脉狭窄患者的临床资料,包括手术成功率、心脑血管并发症以及桡动脉穿刺并发症.指引导管超选目标血管均采用同轴技术.同时选取2014年1月至2015年12月经股动脉入路行颈动脉支架成形术的Ⅲ型主动脉弓合并右侧颈动脉狭窄或牛角型主动脉弓合并左侧颈动脉狭窄患者共20例,比较两组患者的射线投照时间.随访时间为3个月.结果 16例患者的手术成功率为100％.术中出现血压、心率下降3例,无-例出现桡动脉闭塞或严重心脑血管事件.经桡动脉入路行颈动脉狭窄支架成形术患者的射线投照时间[（9.94 ±0.97） min]较经股动脉入路患者[（11.51±1.39）min]减少,两组差异有统计学意义（P =0.001）.结论 对于Ⅲ型主动脉弓合并右侧颈动脉狭窄或牛角型主动脉弓合并左侧颈动脉狭窄患者,经右侧桡动脉入路行支架成形术成功率高,安全可行.

Objective To investigate the feasibility and safety of the treatment of type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach.Methods From September 2015 to February 2016,the clinical data of 16 patients with type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent angioplasty via the radial approach at the Cerebrovascular Interventional Therapy Center,Henan Provincial People＇s Hospital were analyzed retrospectively,including operation success rate,cardio-cerebrovascular complications,and radial artery puncture complications.All 16 patients were treated with endovascular treatment via right radial approach.The coaxial technique was used for guiding catheter to the super-select target vessels.From January 2014 to December 2015,20 patients with type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent operation were selected at the same time.The ray irradiation time between the two groups were compared.The follow-up time was 3 months.Results The surgical success rate of the 16 patients was 100%.Three patients had decreased blood pressure and heart rate during the operation.None of them had radial artery occlusion or severe cardio-cerebrovascular events.The ray irradiation time （9.94 ± 0.97 min） in patients with carotid artery stenosis stenting via the radial approach was less than those via the femoral artery approach（11.51 ± 1.39 min）.There was significant difference （P =0.001）.Conclusion The success rate of the type Ⅲ aortic arch right carotid and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach is high,safe and feasible.