Envoy DA远端血管通路导管在神经介入通路建立中的应用

Application of Envoy DA distal pathway catheter in the establishment of neuro-interventional pathway

目的:探讨Envoy DA远端通路导管在颅内血管内治疗通路建立的有效性及安全性。方法:回顾性分析2019年6月至12月,首都医科大学附属北京安贞医院神经介入科连续使用Envoy DA导管,行症状性颅内动脉硬化性狭窄、颅内未破裂动脉瘤、硬脑膜动静脉瘘及颅内动静脉畸形血管内治疗通路建立患者42例的病例资料,记录患者一般临床资料、Envoy DA导管到位血管的部位及手术相关并发症等。结果:42例患者中,未破裂颅内动脉瘤29例,症状性颅内动脉粥样硬化性狭窄10例,硬脑膜动静脉瘘2例,颅内动静脉畸形1例。Envoy DA导管到达颈内动脉岩段垂直段24例(77.4%),岩段水平段3例(9.6%),鞍前段2例(6.5%),海绵窦段2例(6.5%);后循环病变100%到位于椎动脉V2段及以远部位。2例DAVF及1例AVM Envoy DA导管到位于颈外动脉起始处。术后出现1例非导管相关的缺血并发症。4例(9.5%)因Envoy DA导管在颈内动脉操作时出现痉挛,术中观察5 min后,血管痉挛完全缓解。结论:Envoy DA导管可安全建立颅内血管疾病的通路建立,为颅内不同血管疾病血管内治疗提供了稳定和安全的操作路径。

Objective:To explore the effectiveness and safety of the establishment of the pathway catheter of the Envoy DA in intracranial endovascular treatment.Methods:Retrospectively analyzed data of continuous 42 patients with symptomatic intracranial arteriosclerotic stenosis,intracranial unruptured aneurysm,dural arteriovenous fistula,intracranial arteriovenous malformation,who received Envoy DA catheter as pathway for treatment in the neuro-intervention department of Beijing Anzhen hospital,Capital Medical University from June to December 2019.They were recorded the clinical data,location of Envoy DA catheter,complications,etc.Software SPSS 25.0 was used for data analysis.Results:Among 42 patients,29 were unruptured aneurysm,10 were symptomatic intracranial atherosclerotic stenosis,2 were dural arteriovenous fistula and 1 was intracranial arteriovenous malformation.Envoy DA catheter reached the vertical petrous segment of the internal carotid artery(ICA)in 24 cases(77.4%),the horizontal petrous segment of ICA in 3 cases(9.6%),the anterior sellar segment of ICA in 2 cases(6.5%),the cavernous sinus segment of the internal carotid artery in 2 cases(6.5%),and posterior circulatory lesions totally located in vertebral artery V2 and distal position.Envoy DA catheter in two cases of DAVF and one case of AVM Envoy DA catheter were located at the beginning of the external carotid artery.Postoperative complications of non-catheter-related ischemic stroke in 1 case.Four cases(9.5%)showed complete recovery from vasospasm after observation for 5 minutes because of manipulating Envoy DA catheter in ICA.Conclusions:Envoy DA catheter can safely establish the pathway of intracranial vascular disease,also provide a stable and safe pathway for the endovascular treatment of different intracranial vascular diseases.