颈外动脉支架成形术治疗放疗相关颈内动脉闭塞的疗效分析  

Efficacy analysis of external carotid artery stent angioplasty for radiotherapy-related internal carotid artery occlusion

作　　者：齐辉[1] 尹卫[1] 韩宗利[1] 黄达[1] 徐石峰[1] 

机构地区：[1]北京大学深圳医院神经外科,深圳518000

出　　处：《中国微侵袭神经外科杂志》2015年第11期487-490,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：深圳市科创委2014年基础研究项目(编号:JCYJ201404141623387997)

摘　　要：目的分析颈外动脉支架成形术治疗头颈部放疗后颈内动脉闭塞同时合并颈外动脉重度狭窄的有效性和安全性。方法回顾性分析7例鼻咽癌头颈部放疗后合并颈外动脉重度狭窄的颈内动脉闭塞病人的临床资料。所有病人经DSA确诊,颈内动脉均自分叉部闭塞,6例颈外动脉起始部狭窄〉70%,其中有3例狭窄累及颈总动脉,1例为颌内动脉起始部狭窄〉70%,6例通过颌内动脉-眼动脉向颈内动脉颅内段代偿供血。1例通过颞浅动脉搭桥向大脑中动脉供血。所有病人行局麻下颈外动脉支架成形术,4例应用药物涂层支架,3例应用颈动脉支架。结果手术成功率100%,残余狭窄率〈10%。无围手术期严重并发症。术后1周症状改善4例,消失3例。随访12~24个月,无新发脑缺血事件。结论对于放疗相关的颈内动脉闭塞病人,如果颈外动脉成为颅内主要供血动脉,应用支架成形术治疗颈外动脉重度狭窄能够改善脑缺血症状,手术方法安全、简单、有效。Objective To analyze the efficacy and safety of the external carotid artery（ECA） stent angioplasty for internal carotid artery occlusion（ICAO） combined with severe ECA stenosis after radiotherapy of the head and neck. Methods Clinical data of 7patients with ICAO combined severe ECA stenosis after radiotherapy for nasopharyngeal carcinoma were analyzed retrospectively. All the patients were definitely diagnosed by DSA and the occlusion started from the carotid bifurcation. Six patients had stenosis more than 70% in initiation part of the external carotid artery including 3 patients with stenosis involving the common carotid artery, and 1patient had stenosis more than 70% in the initiation part of the internal maxillary artery IMA. The IMA-ophthalmic artery compensated the intracranial segment of the ICA in 6 patients and 1 patient underwent a superficial temporal artery-middle cerebral artery bypass surgery. All the patients underwent ECA stent angioplasty under local anesthesia including 4 receiving drug-eluting stents and 3 carotid artery stents. Results The surgical success rate was 100% and the residual stenosis was less than 10%. No serious perioperative complications. Symptoms were improved in 4 patients and disappeared in 3 1 week after the operation. All the patients were followed up for 12 to 24 months, no new cerebral ischemic events occurred. Conclusions For patients with radiotherapy-related ICAO, if the ECA becomes the major intracranial artery, application of stent angioplasty for severe stenosis of ECA can improve the symptoms of cerebral ischemia, and the surgical method is safe, simple and effective.

关 键 词：颈内动脉闭塞 颈外动脉狭窄 支架植入术 鼻咽肿瘤 放疗 

分 类 号：R739.63[医药卫生—肿瘤] R653[医药卫生—临床医学]