颈动脉内膜斑块剥脱联合经股动脉途径顺行开通复合手术治疗Riles 1A型颈总动脉闭塞

Hybrid operation of carotid endarterial plaque stripping combined with transfemoral approach anterograde revascularization for Riles type 1A common carotid artery occlusion

目的观察颈动脉内膜斑块剥脱联合经股动脉途径顺行开通复合手术治疗Riles 1A型颈总动脉(CCA)闭塞的效果。方法回顾性分析16例接受颈动脉内膜斑块剥脱联合经股动脉腔内途径顺行开通CCA闭塞病变复合手术的症状性Riles 1A型CCA闭塞患者,记录围手术期并发症;观察术后定期复查头颈部CT血管造影(CTA)、数字减影血管造影(DSA)有无CCA再狭窄,复查CT灌注成像(CTP)评估灌注情况,采用改良Rankin评分量表(mRS)评估临床预后。结果对16例均顺利完成手术,技术成功率100%。术后1天1例少量基底核区渗血、1例切口血肿,经对症处理后恢复。术后2例出现无症状性支架内再狭窄,再狭窄部位均位于CCA开口部,均经再次支架成形术解除狭窄。随访期间无同侧短暂性脑缺血发作或卒中,中位mRS评分0分。结论颈动脉内膜斑块剥脱联合经股动脉途径顺行开通复合手术治疗症状性Riles 1A型CCA闭塞安全、有效。

Objective To observe the efficacy of hybrid operation of carotid endarterial plaque stripping combined with transfemoral approach anterograde revascularization for Riles 1A common carotid artery(CCA)occlusion.Methods Data of 16 patients with symptomatic Riles 1A CCA occlusion who underwent hybrid operation of carotid endarterial plaque stripping combined with transfemoral approach anterograde revascularization were retrospectively analyzed.The perioperative complications were observed,and regular postoperative follow-up was conducted.Head and neck CT angiography(CTA)or digital subtraction angiography(DSA)were performed to assess whether there was restenosis of CCA,CT perfusion(CTP)imaging was used to observe perfusion,while modified Rankin scale(mRS)was used to evaluate clinical prognosis.Results The operations were successfully completed in all 16 patients,and the technical success rate was 100%.One patient had a small amount of blood leakage in the basal ganglia and 1 patient had the wound hematoma 1 day after operation,and then recovered after symptomatic treatment.During the follow-up,asymptomatic in-stent restenosis occurred in 2 cases,both located at the opening of the common carotid artery and relieved after restenting.No ipsilateral recurrence of transient ischemic attack nor stroke happened,and the median mRS score was 0.Conclusion Hybrid operation of carotid endarterial plaque stripping combined with transfemoral approach anterograde revascularization was effective and safe for Riles 1A CCA occlusion.