Envoy DA导管治疗合并颈动脉迂曲前循环动脉瘤的临床体会

Clinical experience of Envoy DA catheter in the treatment of anterior circulation aneurysms with carotid artery tortuosity

目的评价使用Envoy DA导管治疗合并颈动脉迂曲前循环动脉瘤的通过性、支撑性和安全性。方法分析2017年1月—2020年12月在泾县医院收治合并颈动脉迂曲前循环动脉瘤使用DA导管的患者共49例,分析患者临床资料、导管到位时间、使用同轴技术数量、动脉瘤介入治疗前和结束时导管头端的位置、导管相关并发症、动脉瘤栓塞程度以及患者预后。结果所有患者DA导管均顺利到位,导管平均到位时间(9.2±5.6)min,其中10例(20.4%)应用同轴技术将DA导管超选至颈内动脉。治疗前DA导管到位颈内动脉海绵窦段8例,岩骨水平段15例,岩骨垂直段26例,治疗结束时造影示有9例(18.4%)导管头端下移,其中有2例(4.1%)因导管下移至颈内动脉颈段,更换长鞘+DA导管的同轴双导管系统。3例(6.1%)导管到位后出现血管痉挛,给予动脉泵入尼膜同痉挛缓解。其他病例未出现导管相关性并发症。3个月随访时mRS评分,0分33例,1分10例,2分6例。结论Envoy DA导管在合并迂曲颈动脉的前循环动脉瘤栓塞过程中,具有良好通过性且能提供足够支撑力。

Objective To evaluate the navigability,supportability,and safety of the Envoy DA catheter in the treatment of anterior circulation aneurysms with carotid artery tortuosity.Methods A total of 49 patients with anterior circulation aneurysms with carotid artery tortuosity who were treated with DA catheters in Jingxian Hospital from January 2017 to December 2020 were analyzed.The clinical data,time of catheter placement,number of coaxial techniques,location of the catheter tip before and at the end of interventional therapy for aneurysms,catheter-related complications,aneurysm embolization degree,and prognosis were analyzed.Results The DA catheters were successfully navigated to the target position in all patients,and the average time of catheter placement was 9.2±5.6 min.The co-axial technique was used to position the DA catheter in the internal carotid artery(ICA)in 10(20.4%)patients.The location of the DA catheter before treatment involved the cavernous segment of the ICA in 8 patients,the horizontal petrous segment in 15 patients,and the vertical petrous segment in 26 patients.The final angiogram at the end of treatment showed that the catheter tip moved downward in 9(18.4%)patients,of whom 2(4.1%)patients underwent replacement of the catheter with the coaxial double catheter system of long sheath+DA catheter because the catheter moved downward to the carotid segment of the ICA.Vasospasm occurred in 3(6.1%)patients after the DA catheters were in place,and the vasospasm was relieved by pumping nimotop in the artery.There were no catheter-related complications in other patients.After 3 months of follow-up,the modified Rankin scale score was 0 in 33 patients,1 in 10 patients,and 2 in 6 patients.Conclusions Envoy DA catheter has good navigability and can provide sufficient support during the endovascular embolization of anterior circulation aneurysms with tortuous carotid artery.