内膜剥脱治疗颈动脉残腔综合征的疗效观察

Efficacy observation of endarterectomy in treatment of carotid artery stump syndrome

背景与目的:单侧颈内动脉(ICA)慢性闭塞后,仍有3%~5%的患者会出现黑懵、头晕等脑缺血症状,在标准的药物治疗无效时,手术治疗可作为其治疗方案之一。但目前国内对其临床诊断的病例较少,并且对手术方式的认识不足,故本研究初步探讨了以颈外动脉(ECA)、颈总动脉(CCA)或ICA内膜剥脱为主并联合ICA的残腔缝合或切断的方式治疗颈动脉残腔综合征(CSS)的安全性和有效性。方法:回顾性分析2015年8月—2018年6月9例诊断为CSS并经内膜剥脱治疗的患者临床与随访资料,其中男6例,女3例;平均年龄67.3岁。比较手术前后临床症状的变化,记录手术前后改良Rankin量表(mRS)评分情况。结果:9例患者手术均顺利结束,术后头晕、肢体乏力等神经症状均得到缓解和好转,短暂性脑缺血发作(TIA)次数明显减少,但1例患者因失明时间较长,其视力仍无法缓解。2例(22.2%)出现头痛、烦躁等高灌注表现,经药物降压和脱水治疗后好转,无脑出血、脑梗死等严重并发症;有2例术后出现饮水呛咳,但均于术后1周基本恢复。mRS评分结果较术前降低(≥1分)。结论:以ECA、CCA或ICA内膜剥脱为主并联合颈内动脉的残腔缝合或切断的方式治疗CSS是一种安全、可行的治疗方法,其短期随访结果较为满意,可作为药物治疗无效时可采取的一种手术方法。

Background and Aims:After the chronic occlusion of unilateral internal carotid artery(ICA),there are 3%-5%of patients will still have symptoms of cerebral ischemia,such as black-outs and dizziness.However,there are few cases of clinically diagnosed this condition in China at present,and the understanding of its operation method is insufficient.Therefore,this study was conducted to preliminarily investigate the safety and efficacy of the endarterectomy of the external carotid artery(ECA),common carotid artery(CCA)or ICA as the main method combined with the occlusion or resection of the residual lumen of the ICA in treatment of the carotid stump syndrome(CSS).Methods:The clinical and follow-up data of 9 patients diagnosed with CSS and treated by endarterectomy from August 2015 to June 2018 were analyzed retrospectively.Of the patients,6 cases were males and 3 cases females,with an average age of 67.3 years.The changes in clinical symptoms before and after operation were compared.The scorers of the modified Rankin Scale(mRS)before and after operation were recorded.Results:All procedures were uneventfully completed in the 9 patients.After operation,the neurological symptoms such as dizziness and limb weakness were relieved and improved,and the frequency of TIA was significantly reduced,but the visual loss in one patient could not be relieved due to the long period of blindness.Two patients(22.2%)had headache,dysphoria and other high perfusion manifestations,which were improved after decompression and dehydration treatment,without serious complications such as cerebral hemorrhage and cerebral infarction;two patients had choking cough when drinking water after operation,but basically recovered one week later.The scores of mRS for all patients were lower than those before procedure(≥1).Conclusion:Endarterectomy of the ECA,CCA or ICA as the main method combined with the occlusion or resection of the residual lumen of the ICA is a safe and feasible method for CSS,with satisfactory short-term follow-up results.So,it can be used as a surgical method when the drug treatment fails.