颈动脉蹼的临床特点及显微外科治疗  

Clinical features and microsurgical treatment of carotid web

作　　者：马克杰 申晓平 李俊青 王彦 宋志俊 Ma Kejie;Shen Xiaoping;Li Junqing;Wang Yan;Song Zhijun(Department of Neurosurgery,Xingtai Third Hospital,Xingtai,Hebei 054000,China;不详)

机构地区：[1]河北省邢台市第三医院神经外科,054000 [2]河北省邢台市第三医院神经内科,054000 [3]河北省邢台市第三医院超声科,054000 [4]河北省邢台市第三医院麻醉科,054000

出　　处：《中国脑血管病杂志》2022年第11期763-769,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：邢台市重点研发项目(2021ZC102)。

摘　　要：目的探讨颈动脉蹼的临床及影像学特点,并阐述关于颈动脉蹼治疗方案及预后的经验。方法回顾性分析2020年11月至2022年3月邢台市第三医院神经外科连续收治的6例行颈动脉内膜切除术且经病理证实为颈动脉蹼患者的基线、临床资料[包括性别、年龄、本次入院病因、脑血管疾病危险因素、入院时美国国立卫生研究院卒中量表(NIHSS)评分、临床表现、责任血管、静脉溶栓、机械取栓、改良脑梗死溶栓(mTICI)分级、入院后7 d NIHSS评分]、颈动脉蹼的神经影像学资料及颈动脉内膜切除术情况。术后每3个月于门诊行颈动脉彩色多普勒超声随访再狭窄及颈动脉蹼复发情况,并随访是否存在卒中复发。结果6例患者中,2例为无症状;4例以急性前循环脑梗死起病的症状性患者平均NIHSS评分为13.25分,梗死灶分布符合栓塞性特点。4例症状性患者中,1例行静脉溶栓治疗,2例行静脉溶栓后桥接取栓治疗,均恢复良好(mTICI分级为2b~3级)。6例患者颈动脉彩色多普勒超声均提示存在颈动脉蹼,其中4例症状性患者彩色多普勒超声中,3例提示存在颈动脉蹼伴血栓形成,1例提示伴斑块形成;2例无症状患者中,1例合并重度颈动脉狭窄,1例合并颈动脉夹层。6例颈动脉彩色多普勒超声检查结果均与术后病理相同。6例患者均接受颈动脉内膜切除术,手术均成功。在术后平均10.17个月的随访中,均无卒中及颈动脉蹼复发,其中1例出现轻度再狭窄。结论颈动脉蹼远端存在血液瘀滞导致血栓形成,可引起动脉栓塞性脑梗死。颈动脉彩色多普勒超声可有助于颈动脉蹼的诊断及随访。在急性期采取静脉溶栓或桥接介入取栓治疗可能是获益的。颈动脉内膜切除术可能是降低颈动脉蹼相关卒中复发风险的有效手段。Objective To explore diagnostic imaging and clinical features of carotid web,and to describe the microsurgical treatment schedule and outcome.Methods A retrospective analysis was carried out in six patients with carotid web confirmed by carotid endarterectomy and postoperative pathology.Baseline and clinical data(gender,age,etiology of admission,cerebrovascular risk factors,the National Institute of Health Stroke scale[NIHSS]score on admission,clinical manifestations,responsible vessels,intravenous thrombolysis,mechanical thrombectomy,modified cerebral in infarction thrombolysis[mTICI],and NIHSS score 7 days after admission),neuroimaging of carotid web,and conditions of carotid endarterectomy were collected.Carotid artery color Doppler ultrasound was performed every 3 months after surgery to follow up restenosis and recurrence of carotid artery web,as well as recurrence of stroke.Results Among the 6 patients in this study,2 patients were asymptomatic,and the other 4 patients were onset with acute anterior circulation cerebral infarction.The average NIHSS score was 13.25 points in patients with symptoms,and the distribution of infarction foci was consistent with embolic characteristics.Among the 4 symptomatic patients,1 patient received intravenous thrombolysis and 2 patients received bridging thrombectomy after intravenous thrombolysis.All recovered well(mTICI 2b-3).Carotid artery color Doppler ultrasound showed the presence of carotid web in all patients.Among the 4 symptomatic patients,ultrasound showed carotid web with thrombosis in 3 patients and plaque formation in 1 patient.In asymptomatic patients,one was combined with severe carotid artery stenosis and the other with carotid dissection.The results of carotid artery color Doppler ultrasonography in all 6 cases were consistent with postoperative pathology.All patients accepted carotid endarterectomy with a successful rate of 100%.There was no recurrence of stroke and carotid web during a mean follow-up of 10.17 months after operation,and one case had mild r

关 键 词：颈动脉蹼 颈动脉内膜切除术 神经影像学 

分 类 号：R743[医药卫生—神经病学与精神病学]