経橈骨動脈アプローチによる頚動脈ステント留置術

概要

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Objective: A transfemoral approach is usually used for carotid artery stenting (CAS), but postoperative recovery is painful. A transbrachial approach may result in puncture site complications, pain in the forearm, or sensory loss, and can also result in median nerve palsy due to subcutaneous bleeding. To reduce the postoperative burden on the patient and mitigate the potential for complications, transradial CAS (TR-CAS) was performed at our institution, as reported here.Methods: TR-CAS was performed on 20 lesions in 19 patients (4 female, 15 male; mean age, 69.9 years [range 59-83]; 14 symptomatic lesions, 6 asymptomatic lesions) from August 2010 to December 2011. The right carotid artery was stented in 17 patients and the left was stented in 3.Results: Stents were placed in all patients. Cerebellar infarction was noted in 1 patient and subcutaneous bleeding in the forearm was noted in another. No puncture site problems were noted. Caution was required since protracted radial artery puncture could lead to vasospasms, the guidewire could be misdirected into small branches, and patients could have anatomical variations such as absence of the ulnar artery or the presence of an ulnar loop.Conclusion: TR-CAS is not a difficult procedure for an interventional neuroradiologist and is less invasive for the patient.
特定非営利活動法人日本脳神経血管内治療学会の論文