内膜剥脱术治疗严重颈内动脉扭曲研究

Surgical treatment for severe distortion of the internal carotid artery

目的探讨手术治疗重度颈内动脉扭曲的可能性及经验教训。方法对聊城市脑科医院神经外科自2008年7月至2010年5月收治的10例重度颈内动脉扭曲患者应用内膜剥脱术治疗，同时回顾2010年宣武医院治疗的1例颈内动脉扭曲患者的临床资料，其中7例患者同时行外翻式颈内动脉内膜切除术切除粥样硬化内膜。结果1例扭曲严重患者术后3～5d出现轻度烦躁、失眠，伴轻度头痛，其余患者无手术相关并发症发生。患者术后CTA复查示扭曲血管已拉直．血管通畅良好；术后1周均复查颅脑MR，DWI发现2例患者术侧半卵圆中心新发点状梗死病灶：术后3、6月复查颈内动脉彩超示无一例出现颈内动脉再狭窄，无再次扭曲及血流动力学障碍；1例患者术后6月复查CT脑血流灌注成像示患侧灌注明显好转。随访6～12个月，患者均未再出现短暂性脑缺血发作，1例反应迟钝患者术后精神及反应明显好转。结论对于有明显脑缺血症状的重度颈内动脉扭曲患者，内膜剥脱术是一种有效的治疗方法。

Objective To evaluate and summarize the possibility and experience of reconstructive vascular operation for V-shaped kinking of internal carotid artery. Methods Reconstructive vascular operation was performed in 11 patients with symptomatic V-shaped kinking of internal carotid artery, admitted to our hospitals from July 2008 to May 2010; 7 of them underwent eversion endarterectomy simultaneously. Results One patient with severe distortion appeared mild agitation, insomnia and headache 3-5 d after the operation, but 1 week later, the system disappeared completely. CTA right after the operation showed that the distortion vascular was straight with good vascular patency. All patients rechecked MR diffusion weighted imaging 1 week after the operation, showing that 2 patients had fresh lacunar infarction in the operation side. Carotid ultrasonography showed no restenosis recurrence, distortion or hemodynamic disorders 3 and 6 months after the operation. 1 patient rechecked CT brain perfusion imaging 6 months after the operation, showing obviously improved perfusion. Follow up for 6 months reviewed no other new infarction lesions, no obvious nervous signs or symptoms appeared; no one reappeared TIA or had operative complications. Obvious improvement of spirit and reaction was noted in a patient with slow response. Conclusion Reconstructive vascular operation is an effective surgical approach in kinking and coiling of the internal carotid artery.