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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 177-180. doi: 10.19723/j.issn.1671-167X.2020.01.028

• 论著 • 上一篇    下一篇

复合手术治疗无残端的症状性长段颈内动脉慢性闭塞

贾子昌1,李选1,郑梅2,栾景源1,王昌明1,韩金涛1,△()   

  1. 1. 北京大学第三医院 介入血管外科, 北京　100191
    2. 北京大学第三医院 神经内科,北京　100191
  • 收稿日期:2019-02-20 出版日期:2020-02-18 发布日期:2020-02-20
  • 通讯作者: 韩金涛 E-mail:bmucystal@163.com
  • 基金资助:
    国家自然科学基金(81200969)

Hybrid treatment for symptomatic long-segment chronic internal carotid artery occlusion without stump

Zi-chang JIA1,Xuan LI1,Mei ZHENG2,Jing-yuan LUAN1,Chang-ming WANG1,Jin-tao HAN1,△()   

  1. 1. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-02-20 Online:2020-02-18 Published:2020-02-20
  • Contact: Jin-tao HAN E-mail:bmucystal@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81200969)

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摘要：

目的:总结采用复合手术方法治疗无残端症状性长段颈内动脉慢性闭塞(chronic internal carotid artery occlusion,CICAO)病变的初步经验。方法:回顾性总结分析2015年7月至2017年12月北京大学第三医院介入血管外科采取复合手术的方法进行治疗的12例无残端的症状性长段CICAO患者资料,初步分析手术的安全性及有效性。结果:11例患者获得技术成功,技术成功率91.7%(11/12),仅1例发生主要并发症,该患者术中出现颈内动脉海绵窦瘘,结扎颈内动脉近端后好转。全部12例患者无缺血性及出血性卒中,无死亡病例。10例患者获得随访,随访10~32个月,平均随访时间(19±9)个月,其中1例出现症状性支架内再狭窄,予再次手术治疗后好转。结论:对于经严格筛选的无残端的症状性长段CICAO患者,复合开通手术在技术上可行,有较高的手术安全性及技术成功率。

关键词: 颈动脉狭窄, 颈内动脉, 支架, 血管成形术

Abstract:

Objective: To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump. Methods: Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. Results: In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the pro-ximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment. Conclusion: Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.

Key words: Carotid stenosis, Carotid artery,internal, Stents, Angioplasty

中图分类号: 

  • R543.4

图1

术前DSA显示颈内动脉长段闭塞,起始处基本无残端,经眼动脉代偿,C4段远端显影"

图2

术后DSA显示颈内动脉长段闭塞开通"

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ISSN 1671-167X
CN 11-4691/R
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