リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

大学・研究所にある論文を検索できる 「Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
リケラボ

コピーが完了しました

URLをコピーしました

論文の公開元へ論文の公開元へ
書き出し

Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients

丸山, 史晃 東京慈恵会医科大学 DOI:info:doi/10.1177/1591019920987345

2021.10.22

概要

Background and purpose:
　The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients.

Methods:
　From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received dual antiplatelet drugs before the procedure. Eleven patients (21.2%) (12 procedures) were treated with the DCEA. The rest were treated with TFBA. The main indication of the DCEA was an unfavorable aortic arch or vessel tortuosity. Complications and the duration of the procedure were compared between the two groups.

Results:
　There were no significant differences between the two groups in age, aneurysm location, preoperative antiplatelet use, heparin use, or maximum activated clotting time (ACT) values. All endovascular treatments were successfully performed by DCEA. Among all parameters, the DCEA group had only bigger average aneurysm diameter (14 mm) and higher number of pipeline embolic device (PED) placement (58%). Time to the guiding-catheter placement was not significantly different between the groups (DCEA vs TFBA ¼ 31.0 min vs 24.7 min, p ¼ 0.178). No significant complications of DCEA, such as subcutaneous hematomas, were observed.

Conclusion:
　Even with the use of antiplatelet and anticoagulation therapy, the DCEA can be performed safely for unruptured aneurysms in elderly patients.

論文の公開元へ

関連論文

関連論文をもっと見る

参考文献

1. Mokin M, Snyder KV, Levy E, et al. Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointerv Surg 2015; 7: 108–113.

2. Roche A, Griffin E, Looby S, et al. Direct carotid punc- ture for endovascular thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019; 11: 647–652.

3. Blanc R, Piotin M, Mounayer C, et al. Direct cervical arterial access for intracranial endovascular treatment. Neuroradiology 2006; 48: 925–929.

4. Nii K, Kazekawa K, Onizuka M, et al. Direct carotid puncture for the endovascular treatment of anterior cir- culation aneurysms. Am J Neuroradiol 2006; 27: 1502–1504.

5. Dorfer C, Standhardt H, Gruber A, et al. Direct per- cutaneous puncture approach versus surgical cutdown technique for intracranial neuroendovascular proce- dures: technical aspects. World Neurosurg 2012; 77: 192–200.

6. Ishibashi T, Aoki K, Kakuto R, et al. Pipeline emboli- zation device insertion using a direct exposure transcar- otid approach. Noushinkei Kekkannai Tiryou 2018; 12: 567–572.

7. Murayama Y, Arakawa H, Ishibashi T, et al. Combined surgical and endovascular treatment of com- plex cerebrovascular diseases in the hybrid operating room. J Neurointerv Surg 2013; 5: 489–493.

8. Kan I, Ishibashi T, Sakuta K, et al. Preoperative light transmission aggregometry values predict for thrombo- embolic complications after stent-assisted coil emboli- zation. World Neurosurg 2020; 134: 731–738.

9. Bhogal P, Phillips TJ and Makalanda HLD. Direct carotid puncture for flow diverter stent insersion. J Neurosci Neurol Disord 2017; 1: 24–28.

10. Guimaraens L, Theron J, Casasco A, et al. Carotid artery stenting by direct percutaneous puncture. J Vasc Surg 2011; 54: 249–251.

11. Matsumoto H, Fujita K, Miki J, et al. Direct carotid approach for carotid angioplasty and stenting with small incision: a technical case report. No Shinkei Geka 2004; 32: 735–740.

12. Gonzalez NR, Dusick JR, Duckwiler G, et al. Endovascular coiling of intracranial aneurysms in elderly patients: report of 205 treated aneurysms. Neurosurgery 2010; 66: 714–721.

13. Gizewski ER, Goricke S, Wolf A, et al. Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes. Am J Neuroradiol 2008; 29: 1575–1580.

14. Basche S, Eger C and Aschenbach R. The brachial approach for catheter interventions – indications, results, complications. VASA 2004; 33: 235–238.

15. Lee DG, Lee DH, Shim JH, et al. Feasibility of the transradial or the transbrachial approach in various neurointerventional procedures. Neurointervention 2015; 10: 74–81.

16. Iwata T, Mori T, Tajiri H, et al. Initial experience of a novel sheath guide for transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circula- tion. Neurosurgery 2013; 72: 15–20.

17. Eskioglu E, Burry MV and Mericle RA. Transradial approach for neuroendovascular surgery of intracranial vascular lesions. J Neurosurg 2004; 101: 767–769.

18. Nelson P, Lylyk P, Szikora I, et al. The pipeline embolization device for the intracranial treatment of aneurysms trial. Am J Neuroradiol 2011; 32: 34–40.

19. Szikora I, Berentei Z, Kulcsar Z, et al. Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the budapest experience with the pipeline embolization device. Am J Neuroradiol 2010; 31: 1139–1147.

20. Carey D, Martin JR, Moore CA, et al. Complications of femoral artery closure devices. Cathet Cardiovasc Intervent 2001; 52: 3–7.

21. Yeni H, Axel M, O€ rnek A, et al. Clinical and subclinical femoral vascular complications after deployment of two different vascular closure devices or manual compres- sion in the setting of coronary intervention. Int J Med Sci 2016; 13: 255–259.

22. Cuellar H, Guimaraens L, Ambekar S, et al. Angioseal as a hemostatic device for direct carotid puncture during endovascular procedures. Interv Neuroradiol 2015; 21: 273–276.

23. Blanc R, Mounayar C, Piotin M, et al. Hemostatic clo- sure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note. Am J Neuroradiol 2002; 23: 978–981.

参考文献をもっと見る