| Part Ⅰ: Clinical Research for the Improved Transradial Approach Carotid Artery StentingBackground and Objective Femoral artery is the Conventional approaches of CAS,but the complications is high and comfort is poor.In this study,To evaluate the feasibility and safty of transradial approach for carotid artery stenting(CAS), summarizes the matters needing attention, technical key points, equipment and technology improvement of transradial approach for CAS,offer a new operation path for CAS.Materials and Methods Retrospective analysis from September 2015 to June 2016, 46 patients underwent carotid artery stenting from the radial approach.Evaluation of technical success rate, cardiac and cerebrovascular and the radial artery puncture complications.Retrospective analysis from January 2014 to December 2015, 46 patients underwent carotid artery stenting from the femoral approach were randomized selected and ray irradiation time between two groups(trans-radial approach, n = 46 vs.trans-femoral approach, n = 46) were compared using un-paired t-test.Retrospective analysis from January 2014 to December 2015,20 patients treated with CAS for right carotid artery stenosis with type-Ⅲ aortic arch and left carotid artery stenosis with bovine type aortic arch via femoral approach were randomized selected and ray irradiation time between two groups(trans-radial approach, n = 20 vs.trans-femoral approach, n = 20) were compared using un-paired t-test.Results The right radial artery were punctured in all patients,the success rate of cerebral angiography were 100%.the success rate of Guiding catheter in place and operation were 98%.major adverse cardiac and cerebrovascular events did not occur in any patient.radial artery asymptomatic occlusion appeared in 1 case. The ray irradiation time of CAS via radial approach compared with femoral approach was no statistically significant difference(P = 0.376). CAS for right carotid artery stenosis with type-Ⅲaortic arch and left carotid artery stenosis with bovine type aortic arch via radial approach [(9.23±1.02)min] could significantly(P= 0.001) reduce ray irradiation time compared with femoral approach[(11.51±1.39)min].Conclusions Transradial approach for carotid artery stenting(CAS) with high success rate,low complication is safe and technically feasible. Via radial artery path CAS did not increase the difficulty of the operation; And overcome the restrictions of occlusion and serious circuity of the femoral artery, the iliac artery and the aorta on the CAS,greatly expanded the indications of CAS; Via the right radial approach for left carotid artery with bovine type aortic arch and right carotid artery type-Ⅲ aortic arch carotid artery stenting can reduce the operation difficulty, shorten the operation time and reduce the risk of surgery.Part Ⅱ:The Impact of Aortic Arch Anatomy on the Choice of Carotid Artery Stending Approach—Analysis of 530 Cases Aortic Arch DSA ImagesBackground and Objective Aorta and its branches is the inevitable path to CAS, referred as "before the brain vessels", its classification and branch variation has a significant effect on CAS.In this study,the aortic arch and its branches vessels were analyzed by digital subtraction angiography(DSA), and observe the aortic arch classification and its branches variation, and to explore the correlation between the aortic arch classification and gender, age, hypertension, diabetes, hyperlipidemia, in order to provide help for neurointervention.Materials and Methods Analysis 530 patients with aortic arch DSA image data and clinical data.of zhengzhou university people’s hospital from January 2015 to December 2016 Male(347 cases,65.5%), female(183 cases,34.5%); mean age 58.3±11.7 years. With Mc Donald, Anson classification method with De Garis classification method of aorta and its branches carried out a statistical analysis on the types of variation.To diameter of the left common carotid artery as a reference for the aortic arch type, measurement of aortic arch roof to BCT openings of the vertical distance, the distance within carotid artery diameter calledⅠ aortic arch, carotid artery diameter greater than 2times called Ⅲ aortic arch, carotid artery diameter within 1 ~ 2 times for Ⅱ aortic arch.And statistical analysis of the aortic arch parting Using SPSS 18.0 software,Statistical methods using univariate analysis method, with statistical significance to Logistic test, P < 0.05 for the difference is statistically significant.Results Aortic arch type: in 530 patients, type Ⅰ arch 231 cases 43.6%(male 143 cases,female 88 cases), type Ⅱ arch 167 cases 31.5%(male 105 cases female 62cases), type Ⅲ arch 132 cases 24.9%( male 99 cases and female 33 cases). Young group(≤44) 95 cases, type Ⅰarch 69 cases,type Ⅱ arch 19 cases, type Ⅲ arch 7cases;of which under the age of30 years,9 cases were Ⅰ type arch. Middle-aged group(45~59 years) 184 cases, type Ⅰarch 99 cases,type Ⅱ arch 54 cases, type Ⅲarch 31cases;eiderly group(≥60years)251caese, type Ⅰarch 63 cases,type Ⅱ arch 94 cases, type Ⅲ arch 94 cases. age, coronary heart disease(CHD), triglycerides,high-density lipoprotein cholesterol 4 indicators were statistically significant in single factor analysis. Multi-factor regression analysis, the results showed that age is independent risk factors for the type Ⅲ aortic arch. 530 cases of patients, 440 cases(81.1%) with normal 3branch, common origin of BCT and LCCA, LSCA 37 cases;LCCA originated from BCT, LSCA 29 cases;BCT, LCCA, LVA, LSCA 18 cases;LCCA and RCCA common trunk,RSCA,LSCA2 case,BCT deficiency, RCCA,LCCA,LVA, LSCA, RSCA last sent from AA 2 cases; LCCA and RCCA originated from BCT, LSCA 1 cases; Incidence of aorta and its branches variation comparison between men and women, there was no statistically significant difference(P﹥0.05).Conclusions The percent of type Ⅲ arch increase significantly in the aged. Variation probability of the aortic arch Branch is relatively high, the most common is common origin of BCT and LCCA and LCCA originated from BCT. The difficulty and risk of CAS via femoral approach for patients with type Ⅲ arch and branches variation were significantly increased. More attentions section should be paid by neurointervention doctor. |
