介入分期开通症状性颈内动脉闭塞可行性临床研究

Clinical feasibility study of interventional staged revascularization for symptomatic internal carotid artery occlusion

目的探讨介入分期开通症状性颈内动脉闭塞(ICAO)的可行性和安全性,以及影响开通成功的因素。方法回顾性分析43例接受介入分期开通支架成形术治疗的症状性ICAO患者,系统分析手术成功率、围术期并发症发生率及影响血管开通的因素。结果 43例患者中36例完成介入分期开通支架成形术,手术成功率为83.7%(36/43)。1个月内新发脑梗死患者手术成功率高于半年内短暂性脑缺血发作患者(P<0.05),ICAO侧眼动脉逆向血流在颈内动脉有反流患者手术成功率高于无眼动脉逆向血流反流患者(P<0.05)。1例患者二期术后3 d出现同侧脑组织少量出血,1例二期术后出现脑过度灌注综合征,另1例一期术后出现同侧脑卒中新发梗死,围术期并发症发生率为6.9%(3/43)。结论介入分期开通症状性ICAO技术上可行,有着较高的安全性。1个月内新发脑梗死、ICAO侧眼动脉逆向血流反流为开通成功的有利因素。

Objective To evaluate the feasibility and safety of interventional staged revascularization in treating symptomatic internal carotid artery occlusion （ICAO）, and to discuss the factors that may affect the successful re-opening of occluded carotid artery. Methods The clinical data of 43 patients with symptomatic ICAO, who had received interventional staged revascularization with subsequent stent angioplasty, were retrospectively analyzed. The success rate, the incidence of perioperative complications and the factors affecting the patency of blood vessels were statistically analyzed. Results Of the 43 patients, interventional staged revascularization with subsequent stent angioplasty was successfully accomplished in 36, the success rate of the procedure was 83.7% （36/43）. The success rate of the procedure in patients who developed new cerebral infarction in the past month was higher than that in patients who had transient ischemic attack in the past 6 months （P〈0.05）. In the case when blood reflux was present in the internal carotid artery, the success rate of the procedure in patients having reverse blood flow in the ophthalmic artery at ICAO side was strikingly higher than that in patients having not reverse blood flow in the ophthalmic artery at ICAO side （P〈 0.05）. One patient developed mild ipsilateral cerebral hemorrhage three days after two-stage operation, one patient developed ipsilateral cerebral hyperperfusion syndrome after two-stage operation, and another patient developed ipsilateral stroke with new infarction. The incidence of perioperative complications was 6.9% （3/ 43）. Conclusion For the treatment of symptomatic ICAO, interventional staged revascularization is technically feasible with higher safety. New cerebral infarction occurring in past one month, the presence of reverse blood flow in the ophthalmic artery at ICAO side are the favorable factors of successful reopening.