颈内动脉急性闭塞不同开通策略选择
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摘要
目的探讨颈内动脉颅外段起始部急性闭塞的不同开通策略及其可行性。方法回顾性分析2015年5月至2018年1月收治的15例颈内动脉起始段急性闭塞患者临床资料。分别采用不同方法(微导管+微导丝、小球囊+微导丝、多功能管+超滑导丝)开通闭塞段,对开通策略制定、手术器械选择及其开通效果进行初步评估。结果 15例患者均成功开通闭塞段血管,发生远端栓塞事件2例。术后90 d随访均恢复良好,无明显后遗症状。结论对于颈内动脉急性闭塞,手术策略上既要提高开通成功率,尽量缩短开通时间,更要兼顾手术安全。微导管、导丝配合通过病变方法应作为首选,但在特殊条件下其它开通方式可作为补充。
Objective To discuss the clinical effect and feasibility of various vascular recanalization techniques in treating acute occlusion of the initial site of extracranial segment of internal carotid artery(ICA). Methods The clinical data of 15 patients with acute occlusion of the initial site of extracranial segment of ICA, who were admitted to authors' hospital during the period from May 2015 to January 2018,were retrospectively analyzed. Different methods, including use of microcatheter plus microguidewire, use of small balloon plus microguidewire, use of multifunctional catheter plus supersmooth wire, were separately adopted to complete the recanalization procedure for occluded vascular segment. The formulation of the recanalization strategy, the selection of surgical instruments, and the therapeutic effect of each recanalization strategy were assessed. Results Successful recanalization of occluded vascular segment was achieved in all15 patients. Distal embolism event occurred in 2 patients. All patients recovered well at 90 days after the treatment, and no obvious sequelae were observed. Conclusion For the treatment of acute ICA occlusion,the formulation of surgical strategy should not only improve the recanalization rate and shorten the operation time as far as possible, but also more attention should be paid to the safety of surgery. The microcatheter plus microguidewire method should be the first choice, and under special conditions other vascular recanalization techniques can be used as a supplement.(J Intervent Radiol, 2019, 28: 312-315)
Objective To discuss the clinical effect and feasibility of various vascular recanalization techniques in treating acute occlusion of the initial site of extracranial segment of internal carotid artery(ICA). Methods The clinical data of 15 patients with acute occlusion of the initial site of extracranial segment of ICA, who were admitted to authors' hospital during the period from May 2015 to January 2018,were retrospectively analyzed. Different methods, including use of microcatheter plus microguidewire, use of small balloon plus microguidewire, use of multifunctional catheter plus supersmooth wire, were separately adopted to complete the recanalization procedure for occluded vascular segment. The formulation of the recanalization strategy, the selection of surgical instruments, and the therapeutic effect of each recanalization strategy were assessed. Results Successful recanalization of occluded vascular segment was achieved in all15 patients. Distal embolism event occurred in 2 patients. All patients recovered well at 90 days after the treatment, and no obvious sequelae were observed. Conclusion For the treatment of acute ICA occlusion,the formulation of surgical strategy should not only improve the recanalization rate and shorten the operation time as far as possible, but also more attention should be paid to the safety of surgery. The microcatheter plus microguidewire method should be the first choice, and under special conditions other vascular recanalization techniques can be used as a supplement.(J Intervent Radiol, 2019, 28: 312-315)
引文
[1] Adams HP Jr, Bendixen BH, Leira E, et al. Antithro mbotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery:a report of the Trial of Org 10172 in Acute Stroke Treatment(TOAST)[J]. Neurology,1999, 53:122-125.
[2] Jovin TG, Gupta R, Uchino K, et al. Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate[J]. Stroke, 2005, 36:2426-2430.
[3] Grubb RL Jr, Derdeyn CP, Fritsch SM, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion[J]. JAMA, 1998, 280:1055-1060.
[4] Derdeyn CP, Grubb RL, Powers WJ. Cerebral hemodynamic impairment methods of measurement and association with stroke risk[J]. Neurology, 1999, 53:251-259.
[5] Mokin M, Kass-Hout T, Kass-Hout O, et al. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion:a systematic review of clinical outcomes[J]. Stroke, 2012, 43:2362-2368.
[6] Jadhav A, Panczykowski D, Jumaa M, et al. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion[J]. J Neurointerv Surg, 2018, 10:1155-1160.
[7] Mishra A, Stockley H, Goddard T, et al. Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke[J]. Interv Neuroradiol, 2015, 21:205-214.
[8] Starke RM, Komotar RJ, Connolly ES. Endovascular therapy in acute ischemic stroke[J]. Neurosurgery, 2013, 72:N20-N23.
[9] Dalyai RT, Chalouhi N, Singhal S, et al. Stent-assisted endovascular recanalization of extracranial internal carotid artery occlusion in acute ischemic stroke[J]. World Neurosurg, 2013,79:143-148.
[10] Kwak JH, Zhao L, Kim JK, et al. The outcome and efficacy of recanalization in patients with acute internal carotid artery occlusion[J]. AJNR Am J Neuroradiol, 2014, 35:747-753.
[11] Stampfl S, Ringleb PA, Moehlenbruch M, et al. Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke[J]. AJNR Am J Neuroradiol, 2014, 35:741-746.
[12] Mpotsaris A, Kabbasch C, Borggrefe J, et al. Stenting of the cervical internal carotid artery in acute stroke management:the karolinska experience[J]. Interv Neuroradiol, 2017, 23:159-165.
[13] Chen ZY, Li M, Li MH, et al. Expansive arterial remodeling of carotid arteries in symptomatic ischemic patients[J]. J Intervent Med, 2018, 1:82-85.
[14] Lockau H, Liebig T, Henning T, et al. Mechanical thrombectomy in tandem occlusion:procedural considerations and clinical results[J]. Neuroradiology, 2015, 57:5895-5898.
[15] Peng YM, Wu YX, Huo XC, et al. Outcomes of anesthesia selection in endovascular treatment of acute ischemic stroke[J].J Neurosurg Anesthesiol, 2019, 31:43-49.
[16]郭建明,谷涌泉,郭连瑞,等.支架成形治疗合并对侧颈动脉闭塞的重度颈动脉狭窄[J].介入放射学杂志, 2015, 24:10-14.
[17]张聪,张勇,纪晓军.急性症状性颈动脉闭塞患者侧支循环的分析[J].中国脑血管病杂志, 2015, 12:180-184.
[2] Jovin TG, Gupta R, Uchino K, et al. Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate[J]. Stroke, 2005, 36:2426-2430.
[3] Grubb RL Jr, Derdeyn CP, Fritsch SM, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion[J]. JAMA, 1998, 280:1055-1060.
[4] Derdeyn CP, Grubb RL, Powers WJ. Cerebral hemodynamic impairment methods of measurement and association with stroke risk[J]. Neurology, 1999, 53:251-259.
[5] Mokin M, Kass-Hout T, Kass-Hout O, et al. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion:a systematic review of clinical outcomes[J]. Stroke, 2012, 43:2362-2368.
[6] Jadhav A, Panczykowski D, Jumaa M, et al. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion[J]. J Neurointerv Surg, 2018, 10:1155-1160.
[7] Mishra A, Stockley H, Goddard T, et al. Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke[J]. Interv Neuroradiol, 2015, 21:205-214.
[8] Starke RM, Komotar RJ, Connolly ES. Endovascular therapy in acute ischemic stroke[J]. Neurosurgery, 2013, 72:N20-N23.
[9] Dalyai RT, Chalouhi N, Singhal S, et al. Stent-assisted endovascular recanalization of extracranial internal carotid artery occlusion in acute ischemic stroke[J]. World Neurosurg, 2013,79:143-148.
[10] Kwak JH, Zhao L, Kim JK, et al. The outcome and efficacy of recanalization in patients with acute internal carotid artery occlusion[J]. AJNR Am J Neuroradiol, 2014, 35:747-753.
[11] Stampfl S, Ringleb PA, Moehlenbruch M, et al. Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke[J]. AJNR Am J Neuroradiol, 2014, 35:741-746.
[12] Mpotsaris A, Kabbasch C, Borggrefe J, et al. Stenting of the cervical internal carotid artery in acute stroke management:the karolinska experience[J]. Interv Neuroradiol, 2017, 23:159-165.
[13] Chen ZY, Li M, Li MH, et al. Expansive arterial remodeling of carotid arteries in symptomatic ischemic patients[J]. J Intervent Med, 2018, 1:82-85.
[14] Lockau H, Liebig T, Henning T, et al. Mechanical thrombectomy in tandem occlusion:procedural considerations and clinical results[J]. Neuroradiology, 2015, 57:5895-5898.
[15] Peng YM, Wu YX, Huo XC, et al. Outcomes of anesthesia selection in endovascular treatment of acute ischemic stroke[J].J Neurosurg Anesthesiol, 2019, 31:43-49.
[16]郭建明,谷涌泉,郭连瑞,等.支架成形治疗合并对侧颈动脉闭塞的重度颈动脉狭窄[J].介入放射学杂志, 2015, 24:10-14.
[17]张聪,张勇,纪晓军.急性症状性颈动脉闭塞患者侧支循环的分析[J].中国脑血管病杂志, 2015, 12:180-184.