复合手术颈内动脉再通术中远端血管栓塞后取栓一例  

Hybrid recanalization for occluded internal carotied artery followed by mechanical thrombectomy for distal artery: a case report and literature review

作　　者：刘青林[1,2] 赵鹏 亓长静[3] 王东海[1] Liu Qinglin;Zhao Peng;Qi Changjing;Wang Donghai(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经外科,济南250012 [2]首都医科大学附属北京天坛医院 北京市神经外科研究所神经介入科 [3]山东大学齐鲁医院护理部,济南250012

出　　处：《中国脑血管病杂志》2019年第1期43-46,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：回顾性分析1例复合手术行慢性颈内动脉闭塞再通术中远端血管栓塞后成功取栓患者的临床资料,并对复合手术治疗慢性颈内动脉闭塞的优势进行讨论。患者为59岁男性,主要临床表现为右侧肢体麻木无力,并伴有反应迟钝;脑血管造影证实左侧颈内动脉起始部溃疡性斑块,右侧颈内动脉闭塞。于神经外科行复合手术右侧颈内动脉再通术,颈动脉内膜切除术切除颈内动脉起始部斑块,术中造影证实斑块切除完全,颈内动脉通畅,同侧大脑中动脉M2不显影,考虑术中斑块脱落或血栓形成导致栓塞性并发症,采用血管内支架置入成功取栓后,造影证实M2通畅。该病例提示复合手术下颈内动脉闭塞再通术可以结合内膜切除及介入再通的优势,根据术中情况灵活地转化手术方案,提高再通率,并能及时进行影像学评估,最大限度地保障手术安全。The clinical characteristics of a patient who received hybrid racanalizaion for chronic occlusion of right internal carotid artery was retrospectively analyzed in this report.The advantages of hybrid operation for such lesion was discussed and reviewed.This patient was a 59 years old man,who suffered from numbness and weakness at right extremities accompanied with clumsy response.DSA revealed ulcerative plaque in the left internal carotid artery and occlusion of the right internal carotid artery.The hybrid operation to racanalize the occluded right internal carotid artery was performed.Firstly,right carotid endarterectomy was perfomed.Intraoperative DSA confirmed right internal carotid artery was recanalized,but the ipsilateral M2 segment became invisible.It was occluded by a detached embolus which was retrieved by a stent to recover the patency of the artery.This case suggested that hybrid recanalization of occluded internal carotid artery could make use of merits of both endarterectomy and interventional techniques,thus increasing the opportunity of recanalization.Besides,control radiological imaging can be performed at any time during operation to better assure patients′safety.

关 键 词：复合手术 颈内动脉闭塞 再通 并发症 取栓 

分 类 号：R651.1[医药卫生—外科学]