使用直接暴露经颈动脉途径插入管道栓塞装置

JNET Pub Date : 2018-07-13 DOI:10.5797/JNET.TN.2017-0130
T. Ishibashi, K. Aoki, Ritsu Kakutou, I. Yuki, Y. Murayama
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引用次数: 1

摘要

目的:增加管道栓塞装置(PED)插入的手术相关选择。病例介绍:一名83岁的女性患者,患有海绵窦右颈内动脉(ICA)脑动脉瘤,正在随访中,随后动脉瘤大小和复视增加,考虑进行手术。诊断性脑血管造影术显示明显的动脉硬化,很难选择性地引导导管进入ICA。因此,为了治疗,我们计划通过直接颈动脉手术暴露直接穿刺颈动脉来插入PED。在全身麻醉下,颈部皮肤切口暴露出颈总动脉。将外科血管固定带放置在颈总动脉上待穿刺部位的远端和近端。使用儿科穿刺试剂盒,将4 Fr鞘插入颈总动脉。接下来,在荧光镜检查下,使用0.035英寸的导丝进入ICA,该导丝被更换为90cm长的6Fr Destination(Terumo Corporation,Tokyo,Japan)。这是经过仔细引导进入ICA的。随后,使用5 Fr Navien 115 cm(Marksman;Covidien,Irvine,CA,USA)将测量为5×35mm的PED插入动脉瘤部位。在动脉穿刺部位进行缝合止血。无术中或术后并发症。结论:颈动脉直接穿刺是治疗因动脉硬化而难以插入PED的患者的有效方法。
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Pipeline Embolization Device Insertion Using a Direct Exposure Transcarotid Approach
Objective: To increase procedure-related options for Pipeline Embolization Device (PED) insertion. Case Presentation: An 83-year-old female patient with a right internal carotid artery (ICA) cerebral aneurysm in the cavernous sinus being on follow-up showed subsequently an increase in the aneurysmal size and diplopia, and surgery was considered. Diagnostic cerebral angiography showed marked arteriosclerosis, and it was difficult to guide selectively a catheter into the ICA. Therefore, for treatment, we planned PED insertion by direct puncture of the carotid artery through direct cervical surgical exposure. Under general anesthesia, a cervical skin incision exposed the common carotid artery. Surgical vessel holding tapes were placed distal and proximal to the site to be punctured on the common carotid artery. Using a pediatric puncture kit, a 4 Fr sheath was inserted in the common carotid artery. Next, under fluoroscopy the ICA was entered using a 0.035-inch guidewire that was exchanged for a 6 Fr Destination 90-cm (Terumo Corporation, Tokyo, Japan) long. This was carefully guided into the ICA. Subsequently, a PED measuring 5 × 35 mm was inserted to the aneurysmal site using a 5 Fr Navien 115 cm (Marksman; Covidien, Irvine, CA, USA). Hemostasis by suture was performed at the site of arterial puncture. There were no intraoperative or postoperative complications. Conclusion: Direct puncture of the carotid artery can be an effective method for patients in whom it may be difficult to insert a PED due to arteriosclerosis.
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来源期刊
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发文量
38
审稿时长
17 weeks
期刊介绍: JNET Journal of Neuroendovascular Therapy is the official journal of the Japanese Society for Neuroendovascular Therapy (JSNET). The JNET publishes peer-reviewed original research related to neuroendovascular therapy, including clinical studies, state-of-the-art technology, education, and basic sciences.
期刊最新文献
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