经右桡动脉入路行颈动脉支架成形术的可行性研究

Right transradial approach for carotid artery stenting

目的探讨经右桡动脉入路（transradial approach，TRA）行颈动脉支架成形术（catotid artery stenting，CAS）的可行性及安全性，初步总结其适应证及手术技巧。方法回顾性分析46例经右TRA行CAS病例资料，根据病变位置将病例分为右颈动脉组（right carotid artery group，RCA）、合并牛角弓左颈动脉组（bovine left carotid artery group，B—LCA）、非牛角弓左颈动脉组（nonbovine carotid anery group．NB—LCA）。选择性采用低位桡动脉入路或高位桡动脉入路行CAS术。术中综合运用长鞘头端体外成形、同轴技术、主动脉瓣成袢反折技术（catheter looping and retrograde engagement technique，CLRET）等技巧解决长鞘支撑不足难点。观察记录手术成功率、手术时间、投射时间及围手术期并发症发生情况。分析比较不同组CAS间手术时间、投射时间差异。结果手术成功率100％，在手术时间及投射时间上，RCA、B—LCA、NB—LCA组间差异无统计学意义，NB—LCA组中CLRET技术使用率为55．56％（10／18），其中合并Ⅲ型弓的8例（8／8），合并Ⅱ型弓的2例（2／6），使用CLRET技术组手术时间[（39．45±7．27）min比（30．80±4．66）min]与放射时间[（11．84±2．05）min比（9．91±1．45）min]较不使用的明显延长，两者差异有统计学意义（P〈0．05）。围手术期未发生严重心脑血管事件及穿刺点并发症。结论经TRA行CAS安全、可行，尤其适用于右侧CAS及合并Ⅰ或Ⅱ型弓的左侧CAS。

Objective To explore the feasibility and safety of carotid artery stenting （CAS） via right transradial approach （TRA）. Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA. Patients were divided into the right carotid artery group （RCA）, bovine left carotid artery group （ B-LCA ）, nonbovine carotid artery group （ NB-LCA ） according to the lesion location. Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique（CLRET）. Results CAS were successful in all cases （ 100% ） , the differences of the operation time and fluoroscopy time among RCA group, B-LCA group and NB-LCA group were not significant. In NB-LCA group, CLRET were applied in 10 cases （ 55.56% , 10/18 ）, includeing 8 cases with type Ⅲ aortic arch （ 100 %, 8/8 ） and 2 cases with type Ⅱ aortic arch （33.33% ,2/6）. The CLRET prolonged the operation time and fluoroscopy time [ （39.45 ± 7. 27 ）min vs. （30. 80 ± 4. 66 ） rain; （ 11.84 ± 2. 05 ） min vs. （ 9. 91 ± 1.45 ） min, P 〈 0. 05 ） . There was no cerebrovascular events and puncture point complications in perioperative period. Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible, especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.