Intracranial arterial stenosis stenting via radial artery approach: four cases report

doi:10.3969/j.issn.1672-6731.2024.05.013

Abstract

Abstract:

Objective: To report 4 cases of intracranial arterial stenosis stenting via radial artery approach and summarize the experience of treatment. Methods and Results: The clinical data and treatment process of 4 patients with ischemic stroke treated by intracranial arterial stenosis stenting via radial artery approach in The Affiliated Hospital of Qingdao University were reviewed in 2022. The stenoses were located in the initial segment of left internal carotid artery (ICA), the initial segment of right vertebral artery (VA), the V4 segment of left VA, and the junction of V4 segment of left VA and the basilar artery, respectively. All the 4 patients underwent transradial approach stenting for ICA stenosis. The surgery was successful and the stenoses were recanalized. No adverse reactions were observed during and after the surgery. Conclusions: Intracranial arterial stenosis stenting via radial artery approach is safe and effective in the treatment of ischemic stroke.

Key words: Ischemic stroke, Radial artery, Cerebral arteries, Angioplasty, Stents

摘要：

目的: 报道4例经桡动脉入路行颅内动脉狭窄支架成形术的缺血性卒中病例并总结其治疗经验。方法与结果: 回顾分析2022年青岛大学附属医院采用经桡动脉入路行颅内动脉狭窄支架成形术的4例缺血性卒中患者的诊断与治疗过程，狭窄分别位于左颈内动脉起始部、右椎动脉起始部、左椎动脉V4段、左椎动脉V4段与基底动脉起始部交界处，经桡动脉入路颅内动脉狭窄支架成形术顺利，术后狭窄均再通，术中及术后无一例出现并发症。结论: 经桡动脉入路颅内动脉狭窄支架成形术治疗缺血性卒中安全、有效。

关键词: 缺血性卒中, 桡动脉, 脑动脉, 血管成形术, 支架

CLC Number:

Mei-yan SHI, Xian-jun ZHANG, Xian-wei WANG, Yong ZHANG, Nai-dong WANG. Intracranial arterial stenosis stenting via radial artery approach: four cases report[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(5): 382-390.

史美燕, 张贤军, 王宪伟, 张勇, 王乃东. 经桡动脉入路颅内动脉狭窄支架成形术四例[J]. 中国现代神经疾病杂志, 2024, 24(5): 382-390.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2024.05.013

https://journal11.magtechjournal.com/cjcnn/EN/Y2024/V24/I5/382

Figures/Tables 7

Figure 1 Head imaging findings on admission Axial DWI showed infarct focus in right frontal lobe (arrow indicates, Panel 1a). CTA showed occlusion in the right ICA, right ACA and distal branches (arrow indicates, Panel 1b) and severe stenosis in the initial segment of left ICA (arrow indicates, Panel 1c).

Figure 2 DSA findings before and after left ICA stenting surgery Preoperative anteroposteric DSA showed right femoral artery occlusion (arrow indicates, Panel 2a). Preoperative anteroposteric DSA showed left femoral artery occlusion (arrow indicates, Panel 2b). Right radial artery approach (Panel 2c). Preoperative lateral DSA showed severe stenosis in the initial segment of left ICA (arrow indicates, Panel 2d). Postoperative lateral DSA showed recanalization in the left ICA (Panel 2e).

Figure 3 DSA findings before and after right VA stenting surgery Preoperative CTA showed severe stenosis at the beginning of right VA (arrow indicates, Panel 3a). Preoperative anteroposteric DSA showed severe stenosis in the initial segment of right VA (arrow indicates, Panel 3b). Intraoperative balloon dilation of the stenosis site (arrow indicates, Panel 3c). Postoperative immediate anteroposteric DSA showed recanalization in the initial segment of right VA (Panel 3d).

Figure 4 Head CT at admission showed multiple mottled hypointensity in both cerebellar hemispheres and circular hyperintensity in the right cerebellar hemisphere.

Figure 5 DSA findings before and after left VA stenting surgery Left radial artery approach (Panel 5a). Preoperative lateral DSA showed severe stenosis in the V4 segment of left VA (arrow indicates, Panel 5b). Immediately after surgery, lateral DSA showed significant improvement in the V4 segment stenosis of left VA (Panel 5c). DSA after 6 months of surgery showed the stent of the V4 segment of left VA was in good shape (Panel 5d).

Figure 6 CTA at admission showed severe stenosis in the junction of the V4 segment of left VA and basilar artery initiation (arrow indicates).

Figure 7 DSA findings before and after basilar artery stenting surgery Preoperative anteroposterior DSA showed severe stenosis in the initial segment of basilar artery (arrow indicates, Panel 7a). Balloon dilation of the stenotic lesion (arrow indicates, Panel 7b). Postoperative anteroposterior DSA showed the terminal segment of the V4 segment of left VA and the initial segment of basilar artery had smooth blood flow (Panel 7c).

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