复合手术治疗5例Riles 1A型颈总动脉闭塞

A report of composite surgery of 5 cases of common carotid artery occlusion of Riles 1A

目的探讨复合手术在治疗Riles 1A型颈总动脉闭塞(common carotid artery occlusion,CCAO)患者中的技术要点、疗效及特殊案例分析。方法回顾性收集2021年6月至2022年6月应用复合手术技术开通的5例Riles 1A型CCAO患者的临床资料,记录围手术期并发症,术后3个月、6个月复查头颈部CTA及DSA观察颈部血管重建情况,采用改良Rankin评分量表(mRS)评估临床预后。结果5例患者病因均为动脉粥样硬化,且均完成手术,4例患者成功开通闭塞血管,1例患者导丝无法突破纤维帽开通失败。所有患者术后临床症状均得到改善。1例患者术后发生高灌注综合征,表现为患侧头痛、恶心、呕吐、血压升高,积极控制血压,给予少量镇痛镇静类药物及甘露醇静脉滴注等后病情好转出院。无患者新发卒中事件,无患者死亡。5例患者均随访6个月,无再狭窄及其他并发症发生,mRS评分平均为0.4分。结论复合手术治疗Riles 1A型CCAO患者安全可行,可能是该类患者的理想手术方案,短期疗效满意。

Objective To discuss the technical points,efficacy and special case studies of the composite procedure in the treatment of patients with Riles type 1A common carotid artery occlusion(CCAO).Methods The clinical data of five patients with recanalization of Riles 1A type CCAO by the composite surgical technique from June 2021 to June 2022 were retrospectively collected,perioperative complications were recorded.Neck revascularization was evaluated by two head and neck CT angiographies(CTA)and digital silhouette angiographies(DSA)on March and June postoperatively and clinical prognosis was assessed using the modified Rankin Rating Scale(mRS).Results All five patients had atherosclerosis as the cause and all completed the procedure.Four patients had successful recanalization of the occluded vessel,while one patient failed to achieve recanalization due to the failure of the guidewire to break through the fibrous cap.All patients had improved clinical symptoms postoperatively.One patient had a postoperative hyperperfusion syndrome presenting with headache,nausea,vomiting and elevated blood pressure on the affected side,and was discharged after aggressive control of blood pressure and administration of a small amount of analgesic and sedative drugs and mannitol intravenously.All five patients were followed up for 6 months without restenosis or other complications and had a mean mRS score of 0.4.Conclusion The composite surgery is safe and feasible in the treatment of patients with Riles 1A CCAO and may be the ideal surgical option for this group of patients with satisfactory short-term outcomes.