症状性Riles 1A型颈总动脉闭塞的血运重建及疗效

Revascularization in symptomatic Riles type 1A common carotid artery occlusion and its efficacy

目的:评价Riles 1A型颈总动脉闭塞(CCAO)的血运重建方式及效果。方法:对2012年8月—2015年6月9例症状性Riles 1A型CCAO患者行血运重建,其中旁路转流5例,原位重建4例。结果:手术均顺利完成,所有患者术后症状消失或明显好转。2例(2/9)出现过度灌注综合征,经严格控制血压、脱水降颅压治疗后好转,无脑出血等严重并发症。随访期间患者一般情况良好,症状明显改善或消失,1例行颈动脉内膜剥脱术联合颈动脉支架置入术患者术后6个月经超声发现支架近端轻中度狭窄(<50%),但患者无自觉症状,未予处理;1例合并冠心病患者术后17个月因心肌梗塞死亡。结论:症状性Riles 1A型CCAO患者行血运重建安全有效;手术方式需个体化选择,原位重建应在有条件医疗机构积极开展。

Objective： To evaluate the methods for revascularization （CCAO） and the efficacy. in Riles type 1A common carotid artery occlusion Methods： From August 2012 to September 2015, 9 patients underwent revascularization for Riles type 1A CCAO. Of the patients, 5 cases underwent bypass graft and 4 cases underwent in situ reconstruction. Results： Operations were successfully completed in all patients, and their symptoms disappeared or were significantly improved after operation. Two patients （2/9） developed hyperperfusion syndrome that improved after strict blood pressure control and reducion of intracranial pressure by cerebral dehydration, and no serious complications such as cerebral hemorrhage occurred. During follow-up period, patients were generally in good condition and their symptoms were significantly improved or disappeared; at 6 months after operation, mild to moderate proximal in-stent stenosis （〈50%） was found by ultrasound in one patient who had combined carotid endarterectomy and carotid artery stenting, but the patient had no subjective symptoms and no treatment was given; one patient with coronary artery disease died due to myocardial infarction 17 months later. Conclusion： Revascularization in Riles type 1A CCAO is safe and effective; the surgical treatment should be individually tailored and the in situ reconstruction should be recommended in qualified medical institutions.