慢性颈内动脉闭塞的研究与治疗进展  

Current study and management of chronic total occlusion of the internal carotid artery

作　　者：马琳[1] 刘保龙[2] 尹龙[1] MA Lin;LIU Bao-long;YIN Long(The Fourth Ward,Department of Neurosurgery;Department of ultrasonography,Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经外科四病区,天津300350 [2]天津市环湖医院超声科,天津300350

出　　处：《岭南现代临床外科》2020年第2期254-260,266,共8页Lingnan Modern Clinics in Surgery

摘　　要：现阶段临床工作中对慢性颈内动脉闭塞(ICACTO)治疗的认识有限。本文通过对慢性颈内动脉闭塞的病理、发病机制、临床症状、影像学特征及治疗等进行总结,综述其相关的研究进展。在颈内动脉完全闭塞后脑组织内丰富的侧支血管开放并逐步形成侧支代偿。ICACTO的病理生理特点是脑灌注不足,栓子脱落和认知功能障碍,最后引起多种卒中不良事件的发生。因此大多数ICACTO病例需要治疗。最初采取颈外动脉-颈内动脉搭桥的方法并没有取得满意的治疗效果。近年来闭塞血管的再通被认为是唯一可行的治疗手段,术前需要评估脑血管储备和氧摄取分数,以及颈内动脉(ICA)闭塞的长度、节段和闭塞时间等等多种因素。对合适的患者可以通过血管内介入,颈动脉内膜切除术(CEA)或复合手术等方法进行血管再通。随着生物材料的发展,简单的再通成功率会逐渐提高。但是,CEA+血管内介入的复合手术应该更符合当前的趋势,因为CEA可以切除颅外段颈动脉粥样硬化斑块,为进一步的血管内介入性提供条件。如果再通成功,通常可以长期稳定地改善患者状况。尽管现有的研究已经得出了一定的研究成果,但仍需要进一步的研究和试验来提高当前对ICACTO的了解。There is a limited understanding on the treatment of chronic carotid artery chronic total occlusion(ICACTO)in clinical work.In this article we reviewed the studies including pathology,pathogenesis,clinical symptoms,imaging features and treatment of ICACTO.Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA.The pathological of ICACTO include cerebral hypoperfusion,emboli detachment and cognitive dysfunction,which ultimately lead to a variety of outcomes.Therefore most ICACTO require treatment.The early studies of external-ICA bypass were unsatisfactory in treatment of ICACTO.Recently,recanalization is considered the only viable option.The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased.The length,height and duration of ICA occlusion are also relevant,though more frequently,the condition depends on multiple factors.Revascularization can be performed by intravascular intervention,carotid endarterectomy(CEA)or hybrid surgery for selected patients.With the development of biomaterials,the simple re-transmission success rate will gradually increase.However,hybrid surgery may be more representative of the current trend,as CEA can remove carotid atherosclerotic plaques and provide conditions for further endovascular intervention.If the revascularization successful,it is usually possible to improve the patient's condition steadily in the long term.Although the existing research has yielded certain research results,further research and studies are needed to improve the current understanding of ICACTO.

关 键 词：颈内动脉 慢性闭塞 病理生理 血管再通 

分 类 号：R654.3[医药卫生—外科学]