放疗后颈动脉狭窄外科处理的时机及术式选择

The timing and surgical choice of surgical treatment for carotid stenosis after radiotherapy

目的评估颈动脉内膜斑块切除术(CEA)及颈动脉支架成形术(CAS)治疗放疗后颈动脉狭窄的安全性及有效性。方法回顾性分析2007年10月至2017年9月第二军医大学长征医院诊治的73例放疗后颈动脉狭窄患者的临床资料,其中36例患者行CEA,37例患者行CAS。结果两组患者围手术期均无并发症发生,随访期间,CEA组1例患者发生一过性脑缺血(1/36),其余未见颈动脉再狭窄,亦无卒中、心肌梗死等不良事件。CAS组2例患者发生一过性脑缺血(2/37),2例患者出现术后再狭窄,1例患者发生心肌梗死。CEA组术后随访期间尚未发现再狭窄及不良事件。结论两种手术方式治疗放疗后颈动脉狭窄均安全有效。其中CEA中远期效果较好,是较理想的手术方式。

Objective To evaluate the safety and efficacy of carotid endarterectomy (CEA)and carotid angioplasty with stenting(CAS)for carotid artery stenosis after radiotherapy.Methods The clinical data of 73 cases with carotid artery stenosis after radiotherapy from October 2007 to September 2017 were analyzed retrospectively.Among them,36 cases underwent CEA and 37 cases underwent CAS.Results No complications occurred during the perioperative period in both groups.During the follow-up period,transient cerebral ischemia occurred in 1 case in the CEA group.There was no in-stent restenosis or adverse events such as stroke or myocardial infarction.In the CAS group,transient cerebral ischemia occurred in 2 cases, postoperative restenosis occurred in 2 cases,and myocardial infarction occurred in 1 case.The restenosis rate and incidence of adverse events were lower in the CEA group.Conclusions Both surgical methods are safe and effective in the treatment of carotid artery stenosis after radiotherapy.CEA surgery can be more beneficial to long-term outcome,and it is supposed to be the preferred surgical method.