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基于经桡动脉入路神经介入手术的主动脉弓上脑供血动脉分型及应用 |
李宸1, 刘斌2, 杨瀚涛1, 高洋1, 刘腾飞1, 周浩1, 江瀛川1, 杨志刚1,3
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1.复旦大学附属中山医院神经外科, 上海 200032;2.上海交通大学医学院附属瑞金医院卢湾分院脑病中心, 上海 200020;3.国家放射与治疗临床医学研究中心,上海 200032
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摘要: |
目的 探讨适合指导经桡动脉入路神经介入手术的主动脉弓上脑供血动脉分型并评估其应用价值。方法 选择2017 年 7 月至 2022 年 2 月拟接受脑血管造影或治疗的 186 例患者。应用主动脉弓上造影、术前 CTA 影像,根据推送力与支撑力作用点的关系,将经桡动脉入路介入手术中进行弓上脑供血动脉超选患者的弓上脑供血动脉分为 1 型(普通型)、2 型(中等难度型)及 3 型(困难型)。比较不同分型患者超选成功率及透视时间。结果 186 例患者共 394 根目标血管, 1 型、2型、3 型分别为 164、151、79 根。1 型血管超选成功率 100%(164/164),透视时间平均(6.98±2.19) s; 2 型血管超选成功率 100%(151/151),透视时间平均(7.16±2.40) s; 3 型血管超选成功率 81.0%(64/79),透视时间平均(14.32±5.10) s。不同分型患者间超选成功率差异有统计学意义(P<0.01); 3 型透视时间与 1 型、2 型差异均有统计学意义(P<0.05)。结论 根据推送力与支撑力作用点关系进行的桡动脉入路弓上脑供血动脉分型有助于指导临床制订个体化经桡动脉入路神经介入治疗策略,其中 3 型目标血管超选成功率相对较低,材料及技术要求更高。 |
关键词: 经桡动脉入路 神经介入 弓上脑供血动脉 分型 |
DOI:10.12025/j.issn.1008-6358.2024.20240199 |
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基金项目:上海市科学技术委员会上海市临床医学研究中心项目(19MC1910300),上海市科技委员会"科技创新行动计划"生物医药科技支撑专项(22S31902400),上海市卫生健康委员会卫生行业临床研究专项(202240126). |
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A new practical classification of superior aortic arch types in transradial access for neurointerventional surgery and its preliminary application |
LI Chen1, LIU Bin2, YANG Hantao1, GAO Yang1, LIU Tengfei1, ZHOU Hao1, JIANG Yingchuan1, YANG Zhigang1,3
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1.Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Department of Neurology, Ruijin Hospital/Lu Wan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai 200020, China;3.National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
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Abstract: |
Objective To investigate the appropriate classification of super-arch cerebral blood supplying branches in transradial access (TRA) for neurointerventional surgery and evaluate its applicational value. Methods A total of 186 patients underwent cerebral angiography or treatment between July 2017 and February 2022 were selected. According to the relationships between the pushing force and the support point evaluated using ortic arch angiography or preoperative CTA images, the superarch cerebral blood supplying branches of patients were divided into type 1 (ordinary type), type 2 (moderate difficulty type), and type 3 (difficult type). The success rate and fluoroscopy time of TRA superselection among patients with different types of superarch cerebral blood supplying branches were compared. Results A total of 394 target blood vessels were included in 186 patients, with164, 151, 79 of type 1, type 2, type 3 vessels, respectively. The superselection success rate in type 1 vessels was 100% (164/164), with an average fluoroscopy time of (6.98±2.19) s, which was 100% (151/151), (7.16±2.40) s, and 81.0% (64/79), (14.32±5.10) s in type 2 and type 3 vessels, respectively. There was a significant difference in the superselection success rate among the three types vessels (P<0.01). There were statistically significant differences in fluoroscopy time between types 1 and 3 vessels and between types 2 and 3 vessels (P<0.05). Conclusions The applicational classifications based on the relationships between the pushing force and the support point may be helpful of optimization of TRA neurointervention treatment strategies. The superselection success rate is related lower in type 3 of target blood vessels, with higher need of special materials and surgical procedures. |
Key words: transradial access neurointervention super-arch cerebral blood supplying branches classification |