Percutaneous Transluminal Angioplasty and Stenting Using an Aspiration Catheter

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  • Yamamoto Nobuaki
    Department of Neurology, Tokushima University Hospital, Tokushima, Tokushima, Japan Department of Advanced Brain Research, Tokushima University, Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
  • Yamamoto Yuki
    Department of Neurology, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Yamaguchi Izumi
    Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Sogabe Shu
    Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Miyamoto Takeshi
    Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Shimada Kenji
    Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Kanematsu Yasuhisa
    Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Morigaki Ryoma
    Department of Advanced Brain Research, Tokushima University, Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Izumi Yuishin
    Department of Neurology, Tokushima University Hospital, Tokushima, Tokushima, Japan
  • Takagi Yasushi
    Department of Advanced Brain Research, Tokushima University, Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan

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<p>Objective: During percutaneous transluminal angioplasty (PTA) for the vertebral artery, occlusion of the subclavian artery using a balloon guiding catheter may be useful to prevent embolism of clots and/or debris distal to an atherosclerotic lesion. However, when placing a balloon guiding catheter at the intended vessels is difficult, it may be useful to use an aspiration catheter (AC) for mechanical thrombectomy as an intermediate catheter to suction way clots and/or debris. We report two cases in which PTA was performed for an atherosclerotic lesion at the intracranial vertebral artery using an AC, which ended without complications.</p><p>Case Presentations: Case 1: A 74-year-old man presented with dysarthria and was admitted to our hospital. MRI revealed severe left vertebral artery stenosis and diffuse cerebral infarct areas at the territory of the posterior circulation. The patient had an abdominal aortic aneurysm and abnormally shaped left tortuous subclavian artery. Therefore, we performed PTA and stenting via the left brachial artery. We guided a 6-Fr long sheath to the left subclavian artery, and a 6-Fr AC for thrombectomy was guided through the long sheath to the V4 portion of the left vertebral artery. Thereafter, PTA was carried out under manual aspiration from the AC. As restenosis at the atherosclerotic lesion occurred after PTA, we performed stenting using a coronary stent system for this lesion under manual aspiration from the AC. No new infarct areas were observed on post-procedural MRI. Case 2: A 74-year-old woman presented with dysarthria and was admitted to our hospital. MRI demonstrated basilar artery occlusion and diffuse cerebral infarct areas at the territory of the posterior circulation. As her symptom worsened after admission, we performed urgent mechanical thrombectomy. We first performed thrombectomy using a stent retriever and then performed PTA and stenting (PTAS) for residual basilar artery stenosis via the AC under manual aspiration.</p><p>Conclusion: When it is difficult to place a guiding catheter at the intended vessels during PTA, an AC may be useful to prevent distal embolization.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 16 (5), 277-282, 2022

    特定非営利活動法人 日本脳神経血管内治療学会

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