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  

Carotid endarterectomy alone or combined with fogarty catheter embolectomy for chronic symptomatic occlusion of the internal carotid artery

作　　者：郝继恒 刘卫东 周光华 林凯 张利勇 邢涛 王继跃 

机构地区：[1]聊城市脑科医院神经外科,山东252000

出　　处：《中华神经外科杂志》2015年第1期27-30,共4页Chinese Journal of Neurosurgery

基　　金：国家“十二五”科技支撑计划（2011BA108B04）

摘　　要：目的 观察颈动脉内膜切除术（CEA）或联合应用Fogarty导管（2F）取栓术治疗慢性症状性颈内动脉闭塞的临床疗效.方法 回顾性纳入2008年4月至2013年12月单纯采用CEA或术中联合Fogarty导管（2F）取栓术治疗的12例慢性症状性颈内动脉闭塞患者,所有患者均为颈内动脉起始处节段性闭塞.7例患者采用单纯CEA手术,3例行CEA联合Fogarty导管（2F）取栓术,2例再通失败后行颈外动脉CEA＋颈内动脉起始处缝扎术.评估其近期及远期临床疗效.结果 12例患者中,术中颈内动脉即刻通畅10例,再通成功的比例为10/12.术后3例出现过度灌注综合征,给予严格控制血压、适当脱水后症状逐步缓解;无脑出血、脑梗死、神经损伤等严重并发症的患者.术后随访5- 64个月,无新发脑梗死患者;10例再通成功者均未出现再闭塞,1例出现轻度狭窄;2例偶有短暂性脑缺血发作（TIA）,但持续时间较术前明显缩短.2例开通失败的患者,1例症状缓解,1例仍有TIA.结论 慢性症状性颈内动脉闭塞患者,CEA或联合Fogarty导管取栓术是安全有效的方法,但需要全面的术前评估及谨慎地选择患者.Objective To investigate the therapeutic effect of carotidendarterectomy （CEA） alone or combined with Fogarty catheter embolectomy in the treatment of chronic symptomatic internal carotid artery occlusion.Methods From April 2008 to December 2013,12 patients with transient ischemic attack （TIA） or minor stroke underwent digital subtraction angiograph to confirmation t of ICA occlusion.All patients underwent operative exploration with CEA or CEA plus Fogarty thrombectomy.Patients who failed revascularization underwent external CEA.and ICA ligation.All clinical and radiological data were retrospectively reviewed.Results CEA in 7 patients and CEA plus Fogarty thrombectomy in 3 patients were performed successfully to restore blood flow of internal carotid artery.External CEA and internal carotid artery ligation were performed in 2 patients.Postoperative CT angiography or DSA imaging demonstrated patency of the internal carotid artery in 10 patients.The ischemic symptoms were relieved in most of the patients.Postoperatively,3 patients suffered from hyperperfusion syndrome,but there were no perioperative stroke or death.The duration of follow-up was 15-66 months.No patient developed a new stroke.No reocclusion but one mild re-stenosis（40%） was detected.2 patients suffered from TIA occasionally.One of the two patients failed in recanalization relieved from the symptom,the another still suffered from TIA.Conclusions Carotid endarterectomy alone or combined with Fogarty catheter embolectomy to treat chronic symptomatic internal carotid artery occlusion is feasible and safe,but preoperative evaluation and selection of patient should be carefully.

关 键 词：颈内动脉 动脉闭塞性疾病 颈动脉内膜切除术 栓子清除术 FOGARTY导管 

分 类 号：R653[医药卫生—外科学]