内膜下再通技术治疗左锁骨下动脉闭塞

目的发展和应用动脉内膜下再通技术作为治疗左锁骨下动脉硬化闭塞症的新途径。方法2例左锁骨下动脉闭塞患者,有典型的左锁骨下动脉窃血症表现。经股动脉穿刺,应用常规方法做顺行动脉腔内再通失败后使用经动脉内膜下再通技术治疗。超滑导丝在导管和长鞘支持下穿入闭塞端动脉内膜下腔,经过闭塞段后顺利重新进入动脉真腔,继而用8mm直径球囊完成闭塞段扩张成形并置入8mm×40mm支架。结果治疗后造影显示左锁骨下动脉形态恢复正常,左椎动脉血流方向转为正常。术后锁骨下动脉窃血症状消失。无动脉损伤或动脉栓塞并发症。结论应用内膜下再通技术治疗左锁骨下动脉闭塞症安全、简便,近期疗效满意。是治疗左锁骨下动脉闭塞时可供选择的另一重要技术途径。

Subintimal recanalization for left subclavian artery total occlusion

Objective To apply a new approach of subintimal recanalization (SIR) treatment for left subclavian artery total occlusion. Methods Two patients with typical symptoms of left subclavian artery steal syndrome underwent antegrade SIR after failed routine intraluminal recanalization. The technique was similar to that used in lower extremity. Supported by catheter and long sheath, a 0.035-inch Terumo guidewire was pushed forward to create a subintimal plane. The guidewire then passed the occluded arterial segment through the subintimal space and re-entry the true lumen successfully. Following procedures included PTA and a 8 mm×40 mm self-expandable stent placement. Results Angiogram showed complete patency of left subclavian artery after treatment and both patients became asymptomatic. No complication occurred during the interventional procedure. Conclusion Subintimal recanalization of left subclavian artery total ccclusion is effective and safe. It offers a feasible alterative when intraluminal recanalization failed.