慢性症状性颈内动脉长节段闭塞再通治疗的初步研究  

Preliminary study of treatment for chronic symptomatic internal carotid artery long-segmental occlusion

作　　者：赵同源[1] 时伟玉 薛绛宇[1] 蔡栋阳 杨博文 李天晓[1] 张鹏[2] Zhao Tongyuan;Shi Weiyu;Xue Jiangyu;Cai Dongyang;Yang Bowen;Li Tianxiao;Zhang Peng(Department of Cerebrovascular Intervention,Henan People′s Hospital,Zhengzhou 450003,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]河南省人民医院脑血管介入科,郑州450003 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华放射学杂志》2019年第12期1107-1111,共5页Chinese Journal of Radiology

摘　　要：目的评价慢性症状性颈内动脉长节段闭塞再通治疗的可行性、安全性及疗效.方法回顾性分析2015年5月至2018年5月,经复合手术(斑块位于颈动脉窦部)或血管内介入(斑块位于颈内动脉闭塞段远端)治疗的51例慢性症状性颈内动脉长节段闭塞(动脉闭塞超过2个解剖节段)患者的资料.记录患者血管开通、围手术期并发症、随访期间卒中事件及再闭塞事件的发生情况.结果51例患者中45例闭塞动脉(88.2%,45/51)成功开通,6例因导丝头端无法通过闭塞远端导致手术失败.25例患者行复合手术治疗,24例(96.0%,24/25)成功开通;26例患者行血管内介入治疗,21例(80.8%,21/26)成功开通.经血管内治疗的患者2例出现围手术期并发症,1例术中血栓移位引起小分支栓塞、1例大面积脑梗死;经复合手术治疗的患者2例出现围手术期并发症,1例颈内动脉海绵窦瘘、1例出现颈内动脉开通术后急性再闭塞.开通成功患者中44例获得临床随访,中位随访时间24个月(7~43个月),无缺血性卒中或死亡发生,34例临床症状改善;44例获得影像随访,中位随访时间8个月(4~28个月),其中6例再闭塞、2例再狭窄.结论慢性症状性颈内动脉长节段闭塞再通治疗技术可行、安全,短期随访临床效果良好,但其远期疗效还有待大样本长期随访研究证实.Objective To evaluate the feasibility,safety and efficacy of the treatment of chronic symptomatic internal carotid artery long-segmental occlusion.Methods Fifty-one cases of chronic symptomatic internal carotid artery long-segmental occlusion(arterial occlusion more than 2 anatomical segments)who were treated with hybrid surgery(plaque located at the carotid sinus)or endovascular revascularization(plaque located at the distal end of the internal carotid artery occlusion)from May 2015 to May 2018 were reviewed.Recanalization,perioperative complications,stroke events,and reocclusion events during the follow-up period were recorded.Results The occlusion was recanalized successfully in 45 of 51 patients(88.2%,45/51),6 patients failed because the guidewire could not cross the distal arterial occlusion.And the technical success rate was 96.0%(24/25)in hybrid surgery and 80.8%(21/26)in endovascular revascularization.Perioperative complications occurred in 2 patients who underwent combined endovascular treatment.One patient had a small branch embolism due to intraoperative thrombus shift,and 1 patient had large area cerebral infarction.The complications occurred in 2 patients who underwent thybrid surgery,including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery.Forty-four patients with successful operation received clinical follow-up,with the median follow-up time of 24 months(7-43 months).No recurrent stroke and death occurred during the follow-up period.Clinical symptoms were improved in 34 cases.Totally 44 patients received imaging follow-up,and during the median imaging follow-up time of 8 month(4-28 months),6 cases had reocclusion,and 2 cases had restenosis.Conclusion The treatment of chronic symptomatic internal carotid artery long-segmental occlusion is technically feasible and safety with good short-term efficacy.However,its exact efficacy remains to be confirmed by long-term follow-up studies with large samples.

关 键 词：颈内动脉 动脉闭塞性疾病 放射学 介入性 血管内手术 

分 类 号：R74[医药卫生—神经病学与精神病学]