Hasan分型A型慢性颈内动脉闭塞的外科治疗  

Clinical efficacy of surgical treatment for Hasan type A chronic internal carotid artery occlusion

作　　者：姜世豪 夏源 艾孜买提江·吐尔逊 麦麦提亚生·麦麦提吐尔逊 王凯[1] 阿西木江·阿西尔 苏日青[1] 卡合尔曼·卡德尔[1] 王增亮[1] 买买提力·艾沙[1] 成晓江[1] 尼扎米丁江·热夏提 JIANG Shi-hao;XIA Yuan;AIZIMAITIJIANG Tuerxun;MAIMAITIYASHENG Maimaitituerxun;WANG Kai;AXIMUJIANG Axier;SU Ri-qing;KAHEREMAN Kadeer;WANG Zeng-liang;MAIMAITILI Aisha;CHENG Xiao-jiang;NIZAMIDINGJIANG Rexiati(Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;School of Nursing,Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院神经外科中心,乌鲁木齐830054 [2]新疆医科大学护理学院,乌鲁木齐830011

出　　处：《中国临床神经外科杂志》2024年第4期193-197,共5页Chinese Journal of Clinical Neurosurgery

基　　金：十三五国家重点研发计划(2016YFC1300800)。

摘　　要：目的探讨Hasan分型A型慢性颈内动脉闭塞(CICAO)的外科治疗方法及临床疗效。方法回顾性分析2019年1月至2022年12月收治的32例Hasan分型A型CICAO的临床资料。术后根据AOL分级评估血管再通情况,其中≥2级为再通成功;术后依据北美NASCRT法评估术后再狭窄(狭窄率≥50%)。术后随访6个月,采用改良Rankin量表(mRS)评分评估预后。结果16例采用血管内治疗,16例采用复合手术治疗;术后血管再通成功22例,未成功10例;治疗成功率为68.7%,其中血管内治疗的成功率为62.5%(10/16),复合手术治疗的成功率为75.0%(12/16)。7例(血管内治疗4例,复合手术治疗3例)术后发生手术并发症,包括高灌注综合征2例、颈内动脉海绵窦2例、血管夹层2例、支架内血栓1例。3例术后发生再狭窄,其中1例有临床症状,接受颞浅动脉-大脑中动脉分流术。术后6个月,mRS评分0~2分27例,3~5分5例。结论Hasan分型A型CICAO病人行血管内治疗及复合手术治疗是安全的、有效的。与血管内治疗相比,复合手术治疗的技术成功率更高、手术并发症发生率更低。Objective To investigate the surgical treatment and outcomes of Hasan type A chronic internal carotid artery occlusion(CICAO).Methods The clinical data of 32 patients with Hasan type A CICAO admitted from January 2019 to December 2022 were retrospectively analyzed.After surgery,the Arterial Occlusive Lesion(AOL)scale was used to measure the degree of recanalization,with grade 2~3 indicating successful reperfusion.The postoperative restenosis(stenosis rate≥50%)was evaluated according to the North American NASCRT method.The patients were followed up for 6 months,and the prognosis was evaluated using the modified Rankin scale(mRS)score.Results Sixteen patients underwent endovascular treatment,and 16 underwent hybrid surgery;successful reperfusion was achieved in 22 patients,while 10 patients failed;the treatment success rate was 68.7%,with a success rate of 62.5%(10/16)for endovascular treatment and 75.0%(12/16)for hybrid surgery.Seven patients(4 endovascular treatment,3 hybrid surgery)had postoperative complications,including hyperperfusion syndrome in 2 patients,cavernous sinus in 2 patients,dissection in 2 patients,and stent thrombosis in 1 patient.Three patients had restenosis,including 1 with clinical symptoms who underwent Superficial temporal artery-middle cerebral artery bypass.At 6 months,a mRS score of 0~2 was achieved in 27 patients and a mRS score of 3~5 in 5.Conclusions Endovascular treatment and hybrid surgery for patients with Hasan type A CICAO are safe and effective.Compared with endovascular treatment,hybrid surgery has a higher technical success rate and a lower incidence of surgical complications.

关 键 词：慢性颈内动脉闭塞 Hasan分型A型 血管内治疗 复合手术 疗效 

分 类 号：R743[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]