对侧颈动脉闭塞病人的颈动脉内膜切除

CAROTID ENDARTERECTOMY FOR PATIENTS WITH CONTRALATERAL CAROTID OCCLUSION

为探讨对侧颈动脉闭塞病人颈动脉内膜切除的指征、术中监测和分流情况及疗效 ,作者回顾性分析了 16例此类病人的临床表现、影像学资料、手术方法和结果。证实对侧颈动脉闭塞者的颈动脉内膜切除风险并非像预料的那样高 ,术中监测、选择性分流和娴熟的手术技巧可以使大多数病人获得满意效果。建议 :凡已出现症状者 ,应尽早施行颈动脉内膜切除 ;暂时无症状者 ,可先行内科治疗 ,并用无创检测方法随访 ,一旦发现狭窄侧颈动脉病变有进展 。

To assess the indication, intraoperative monitoring with selective shunting and surgical outcomes of carotid endarterectomy for patients with contralateral carotid occlusion, the clinical manifestations, imaging data, surgical methods and results of 16 patients were analysed retrospectively. It was verified that the surgical risk of these patients was not as high as prediction,satisfactory results coold be achieved with intraoperative monitoring, selective shunting and skilled surgical techniques. It is reasonable to offer the following typical treatment examples: Carotid endarterectomy should be performed for patients with symptomatic carotid stenosis irrespective of the contralateral carotid occlusion, while medical therapy should be maintained for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. maintained. If the asymptomatic stenosis is found to be progressing in noninvasive testing, then a prophylactic endarterectomy should be considered.