颈动脉内膜切除术治疗颈动脉极重度狭窄或闭塞患者可行性和安全性的评价  

Evaluation of the feasibility and safety of carotid endarterectomy for severe carotid artery stenosis and occlusion

作　　者：焦力群[1] 宋刚[1] 华扬 王天龙 蔡兵 谌燕飞[1] 王亚冰[1] 马妍[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]血管超声科 [3]麻醉科

出　　处：《中国脑血管病杂志》2013年第9期462-467,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家科技支撑计划课题(2011BAI08B00)

摘　　要：目的探讨对颈动脉极重度狭窄(狭窄率为95%～99%)或闭塞患者行颈动脉内膜切除术(CEA)的可行性和安全性。方法回顾性分析首都医科大学宣武医院神经外科2001年1月—2012年12月入院的65例症状性颈动脉极重度狭窄或闭塞患者的临床资料。术前行CT灌注(CTP)或氙CT评价大脑半球的血流灌注情况及经DSA评估病变血管,根据具体病变分别行单纯CEA、CEA+Fogarty球囊取栓、CEA+颈动脉支架置入的复合手术。结果①65例患者均接受DSA评估颈动脉病变,其中颈动脉完全闭塞32例,极重度狭窄33例;采用氙CT评价脑血流15例,其中脑血流量(CBF)部分区域下降6例(40.0%),患侧脑血管反应性(CVR)明显降低11例(73.3%);采用CTP评价32例,CBF部分区域下降11例(34.4%),达峰时间延长32例(100%)。②对65例患者行CEA+Fogarty球囊导管取栓术10例,9例再通;行复合手术4例,一例再通失败;51例单纯行CEA,5例未能再通。本组患者再通率为89.2%。③术后30 d内共5例患者出现卒中,3例为出血性卒中,1例死亡;另2例为缺血性卒中。术后卒中和病死率为7.7%。结论对症状性颈动脉极重度狭窄或闭塞患者,经过严格的适应证选择,术前对颈动脉和大脑半球的血流灌注进行充分的影像学评估后,可行血管再通手术。短期随访显示,CEA及其复合手术治疗具有较好的可行性和安全性。Objective To investigate to the feasibility and safety of carotid endarterectomy （CEA） in patients with severe carotid artmy stenosis and occlusion. Methods The clinical data of 65 patients with severe symptomatic carotid artery stenosis and occlusion admitted in Department of Neurosurgery, Xuanwu Hospital, Capital Medical University between January 2001 and December 2012 were analyzed ret- rospectively. Cerebral hemisphere perfusion was evaluated with CTP or XeCT and the diseased vessels were evaluated with DSA before procedure. The patients were performed CEA only, CEA ＋ Fogarty balloon em- bolectomy, or CEA ＋ carotid stenting respectively according to the specific lesions. Results The carotid lesions of all patients were evaluated with DSA. The cerebral blood flow of 15 patients was evaluated with XeCT, and 32 were evaluated with CTP. Of the 65 patients, 26 performed CEA ＋ Fogarty balloon catheter embolectomy. Three of the 4 patients with carotid artery occlusion recanalized successfully. Of the 22 pa- tients with internal carotid arteu occlusion, 19 recanalized, and the other 3 did not recanalize. Of the 8 patients who performed complex surgery, one failed to reeanalize. Of the 36 patients who performed pureCEA, 5 did not recanalize. The recanalization rate of the patients in this group was 89.2%. Five patients had stroke within 30 days after procedure. Two were hemorrhagic stroke ad one died; the other 2 were is- chemic stroke. The postoperative stroke or mortality rate was 7.7%. Conclusion For patients with symptomatic carotid artery occlusion, recanalization therapy can be performed after a rigorous selection of indications and adequate preoperative radiographic evaluation. The follow-up study has shown a better feasi- bility and safety.

关 键 词：颈动脉疾病 颈动脉内膜切除术 血管重建 

分 类 号：R743.3[医药卫生—神经病学与精神病学]