右侧肱动脉入路左颈动脉支架成形术治疗颈内动脉狭窄合并牛型主动脉弓1例报告

摘要

A 63-year-old female patient suffering from stroke and subsequent frequent transient ischemic attack ( TIA) was treated with carotid artery stenting (CAS) in October 2013 in our department.Preoperative CTA revealed a tight stenosis of the left carotid artery in the bovine arch , but the high location of carotid lesion was not suitable for carotid endarterectomy .Using the right brachial artery as access , we carried out CAS with a F6 long sheath advancing into the left common carotid artery .A Spider Embolic protection device was positioned within the left internal carotid artery distal to the stenosis , then the lesion was routinely dilated , and followed by satisfactory deployment of a self-expending Protege stent .CAS was performed successfully without any complication .The patient recovered well and TIA totally disappeared .Carotid ultrasound showed a patent left carotid artery stent during the one-month follow-up.CAS via the right brachial artery for left carotid stenosis in the bovine arch is feasible and safe .%2013年10月我科收治1例63岁女性左颈动脉狭窄，有左侧脑梗死病史并频繁出现一过性脑缺血发作（ transient ischemic attack ，TIA）。术前CTA检查为牛型主动脉弓，左侧颈内动脉起始部重度狭窄，但位于C2水平不适合行颈动脉内膜切除术。采用全麻下经右侧肱动脉入路穿刺，造影导管选入左颈外动脉，加硬导丝引导F6长鞘选入左颈总动脉建立手术通路，然后常规进行保护伞下的颈动脉球囊扩张和支架成形术。手术成功，未发生任何并发症。术后1个月随访，TIA症状完全消失，颈动脉超声提示左颈内动脉支架术后血流通畅。我们认为经右侧肱动脉入路行支架成形术治疗牛型主动脉弓变异的左侧颈内动脉狭窄是安全、可行的。