PDF(Pubmed)
Abstract：
Endovascular treatment is a standard procedure for subclavian artery stenosis or obstruction. However, great care should be taken to avoid embolic complications to the vertebral artery, and several methods have previously been reported. Hence, as surgical procedures become increasingly complicated, unintended issues may arise during treatment. Here, the authors report a case where the filter-type protection device was caught in the stent because the patient moved during treatment, leading to open surgery to recover the filter-type protection device． A 78-year-old female suffering from a left subclavian steal syndrome underwent stenting due to subclavian artery stenosis. The stenotic lesion was approached via the transfemoral route, and a filter-type protection device was advanced to the vertebral artery via the transbrachial route to prevent embolic complications. As the procedure was performed under local anesthesia, the patient moved during stent deployment proximally to the left vertebral artery origin, and the stent unintentionally advanced distally, covering the vertebral artery and obstructing the retrieval catheter for the filter-type protection device to advance. Failed attempts in recovering the filter-type protection device required open surgery for retrieval. Fortunately, there was no postoperative neurological and radiographic complication, ameliorating her chief complaint． The retriever catheter for the protection device should be advanced beyond the vertebral artery orifice just proximal to the protection device before stenting to avoid such complications while also thoroughly considering the type of anesthesia during treatment．.
摘要：
血管内治疗是锁骨下动脉狭窄或阻塞的标准程序。然而,应该非常小心，以避免椎动脉栓塞并发症，以前已经报道了几种方法。因此，随着外科手术变得越来越复杂，治疗期间可能会出现意想不到的问题。这里,作者报告了一个案例，其中过滤器式保护装置由于患者在治疗期间移动而被夹在支架中，导致开放手术以恢复过滤器型保护装置。一名78岁的女性患有左锁骨下动脉窃血综合征，由于锁骨下动脉狭窄而进行了支架置入术。通过经股动脉途径接近狭窄病变，通过经肱途径将过滤器式保护装置推进至椎动脉，以防止栓塞并发症。由于手术是在局部麻醉下进行的，患者在支架向左椎动脉起点近侧展开期间移动,支架无意中向远端推进，覆盖椎动脉并阻塞回收导管，以便过滤器式保护装置前进。恢复过滤器型保护装置的失败尝试需要进行开放式手术才能恢复。幸运的是,术后没有神经和影像学并发症，改善她的主诉。在置入支架之前，用于保护装置的回收器导管应该被推进到刚刚接近保护装置的椎动脉孔之外，以避免这种并发症，同时也要充分考虑治疗期间的麻醉类型。
