复合手术治疗慢性颈内动脉闭塞初步应用及临床效果
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摘要
目的探讨颈动脉内膜剥脱术(CEA)联合颈动脉支架成形术(CAS)治疗慢性颈内动脉闭塞病变的初步应用及临床效果。方法回顾性分析2016年2月至2017年12月采用复合手术治疗的23例颈内动脉完全闭塞患者临床资料。所有患者均经全脑血管造影证实颈内动脉完全闭塞。CEA联合CAS术后严格随访,影像学检查评估重建血管再狭窄率、再次脑卒中率、改良Rankin量表(mRS)评分和美国国立卫生研究院卒中量表(NIHSS)评分变化,初步分析手术安全性和有效性。结果颈内动脉闭塞开通成功18例。随访期复查造影显示再狭窄率为16.7%(3/18),再次脑卒中率较低为11.1%(2/18),总体mRS评分和NIHSS评分显著下降。结论复合手术作为颈内动脉闭塞治疗的新兴术式,可治疗传统手术方式无法完成的颈内动脉病变,具有良好疗效。
Objective to evaluate the clinical application and curative effect of carotid endarterectomy(CEA) combined with carotid artery stenting(CAS) in treating chronic internal carotid artery occlusive diseases. Methods The clinical data of a total of 23 patients with complete occlusion of internal carotid artery, who were admitted to the First Affiliated Hospital of Soochow University, China, during the period from February 2016 to December 2017 to receive hybrid operation, were retrospectively analyzed. Complete occlusion of internal carotid artery was confirmed by whole cerebral angiography in all patients. CEA combined with CAS was carried out, and strict postoperative follow-up was implemented in all patients.Imaging examination was used to assess the restenosis rate of reconstructed vessels, incidence of secondary stroke was documented, modified Rankin Scale(mRS) score and National Institutes of Health Stroke Scale(NIHSS) score were calculated, and both the safety and the effectiveness of the hybrid operation were preliminarily analyzed. Results Successful re-canalization of internal carotid artery occlusion was achieved in 18 patients. During the follow-up period, reexamination of angiography showed that restenosis rate was16.7%(3/18), and the incidence of secondary stroke was 11.1%(2/18). The overall mRS score and NIHSS score were significantly decreased. Conclusion As a newly-developed surgical mode for internal carotid artery occlusion, hybrid operation is able to accomplish some specific and complicated internal carotid artery diseases, which usually can't be cured by conventional surgery alone, and hybrid operation has satisfactory clinical curative effect.
Objective to evaluate the clinical application and curative effect of carotid endarterectomy(CEA) combined with carotid artery stenting(CAS) in treating chronic internal carotid artery occlusive diseases. Methods The clinical data of a total of 23 patients with complete occlusion of internal carotid artery, who were admitted to the First Affiliated Hospital of Soochow University, China, during the period from February 2016 to December 2017 to receive hybrid operation, were retrospectively analyzed. Complete occlusion of internal carotid artery was confirmed by whole cerebral angiography in all patients. CEA combined with CAS was carried out, and strict postoperative follow-up was implemented in all patients.Imaging examination was used to assess the restenosis rate of reconstructed vessels, incidence of secondary stroke was documented, modified Rankin Scale(mRS) score and National Institutes of Health Stroke Scale(NIHSS) score were calculated, and both the safety and the effectiveness of the hybrid operation were preliminarily analyzed. Results Successful re-canalization of internal carotid artery occlusion was achieved in 18 patients. During the follow-up period, reexamination of angiography showed that restenosis rate was16.7%(3/18), and the incidence of secondary stroke was 11.1%(2/18). The overall mRS score and NIHSS score were significantly decreased. Conclusion As a newly-developed surgical mode for internal carotid artery occlusion, hybrid operation is able to accomplish some specific and complicated internal carotid artery diseases, which usually can't be cured by conventional surgery alone, and hybrid operation has satisfactory clinical curative effect.
引文
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[13]王亚冰,焦力群,谌燕飞,等.复合手术技术治疗复杂颈动脉狭窄和闭塞性疾病[J].中国现代神经疾病杂志,2014,14:93-98.
[14]郝继恒,刘卫东,周光华,等.颈动脉内膜切除术或联合导管取栓术治疗慢性症状性颈内动脉闭塞[J].中华神经外科杂志,2015,31:27-30.
[15]Belczak S,Mulatti GC,Abrao SR,et al.Common carotid artery occlusion:a single-center experience in 40 cases[J].Int JAngiol,2016,25:39-43.
[16]Karathanos C,Sfyroeras GS,Stamoulis K,et al.Hybrid procedures for the treatment of multi-focal ipsilateral internal carotid and proximal common carotid or innominate artery lesions[J].Vasa,2011,40:241-245.
[17]张哲,李莉,景硕,等.一站式复合手术的护理管理[J].介入放射学杂志,2017,26:475-478.
[2]Clouse WD,Ergul EA,Wanken ZJ,et al.Risk and outcome profile of carotid endarterectomy with proximal intervention is concerning in multi-institutional assessment[J].J Vasc Surg,2018,68:760-769.
[3]Macierewicz J,Armon MP,Cleveland TJ,et al.Carotid endarterectomy combined with proximal stenting for multilevel disease[J].Eur J Vasc Endovasc Surg,2000,20:572-575.
[4]Frenkel MB,Renfrow JJ,Singh J,et al.Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion:case report[J].J Neurosurg,2018,129:718-722.
[5]张利勇,张士刚,郝继恒,等.复合手术在颈动脉狭窄病变治疗中的初步应用[J].中国脑血管病杂志,2013,10:594-598.
[6]石进,张英谦,吕强,等.对侧颈内动脉闭塞患者的颈动脉血管内支架置入治疗研究[J].中华神经医学杂志,2007,6:692-696.
[7]郭建明,李俊峰,谷涌泉,等.内膜剥脱联合支架成形治疗颈动脉串联病变[J].介入放射学杂志,2015,24:910-913.
[8]唐文杰,高鹏,王亚冰,等.颈动脉次全闭塞患者支架置入术效果分析[J].中国脑血管病杂志,2016,13:545-548.
[9]凌锋,焦力群.颈动脉内膜剥脱术与支架成形术对颈动脉粥样硬化性狭窄治疗的初步研究[J].中国脑血管病杂志,2006,3:4-8.
[10]Malhotra K,Goyal N,Tsivgoulis G.Internal carotid artery occlusion:pathophysiology,diagnosis,and management[J].Curr Atheroscler Rep,2017,19:41.
[11]Hong JH,Sohn SI,Kang J,et al.Endovascular treatment in patients with persistent internal carotid artery occlusion after intravenous tissue plasminogen activator:a clinical effectiveness study[J].Cerebrovasc Dis,2016,42:387-394.
[12]戴琳孙,连葆强,何理盛,等.介入开通治疗慢性症状性颈内动脉闭塞的初步经验探讨(附四例报道)[J].中华神经医学杂志,2015,14:43-46.
[13]王亚冰,焦力群,谌燕飞,等.复合手术技术治疗复杂颈动脉狭窄和闭塞性疾病[J].中国现代神经疾病杂志,2014,14:93-98.
[14]郝继恒,刘卫东,周光华,等.颈动脉内膜切除术或联合导管取栓术治疗慢性症状性颈内动脉闭塞[J].中华神经外科杂志,2015,31:27-30.
[15]Belczak S,Mulatti GC,Abrao SR,et al.Common carotid artery occlusion:a single-center experience in 40 cases[J].Int JAngiol,2016,25:39-43.
[16]Karathanos C,Sfyroeras GS,Stamoulis K,et al.Hybrid procedures for the treatment of multi-focal ipsilateral internal carotid and proximal common carotid or innominate artery lesions[J].Vasa,2011,40:241-245.
[17]张哲,李莉,景硕,等.一站式复合手术的护理管理[J].介入放射学杂志,2017,26:475-478.