颈动脉狭窄伴重度钙化的外科治疗探讨

Surgical treatment strategies for carotid artery stenosis with severe calcification

目的探讨伴有重度钙化的颈动脉狭窄患者的外科治疗策略及手术技巧。方法选择海军军医大学第二附属医院2020年1月至2023年6月收治的33例颈动脉狭窄伴重度钙化行手术治疗的患者,根据患者机体状态、颈部解剖条件、斑块病变特征等,个体化选择外翻式颈动脉内膜切除术(CEA)、补片成形式CEA、CEA+人工血管置换术、近端脑保护下颈动脉支架成形术(CAS)、远端脑保护下CAS和经颈动脉支架成形术(TCAR)等术式治疗,分析不同手术方式的特点和效果。结果33例颈动脉狭窄伴重度钙化患者中,行外翻式CEA 14例(42.4%),补片成形式CEA 6例(18.2%),CEA+人工血管置换2例(6.1%),近端脑保护下CAS 3例(9.1%),远端脑保护下CAS 7例(21.2%),TCAR 1例(3.0%),术后均未发生严重神经系统手术并发症,随访6个月症状均较前改善或消失。结论对于伴有重度钙化的颈动脉狭窄患者,一般首选CEA,当选用CAS时要注意脑保护装置的使用,降低围术期脑梗死的风险。

Objective To explore the surgical treatment strategies and surgical techniques for carotid artery stenosis patients with severe calcification.Methods A total of 33 patients with carotid artery stenosis with severe calcification undergoing surgical treatment were selected from the Second Affiliated Hospital of Naval Medical University from January 2020 to June 2023.Individual selection of valgus CEA,patch CEA,carotid endarterectomy+artificial vascular interplacement,CAS under proximal brain protection,CAS under distal brain protection and TCAR were performed to analyze the characteristics and effects of different surgical methods.Results Among the 33 patients with carotid artery stenosis and severe calcification,14 patients(42.4%)underwent inversion CEA,6 patients(18.2%)underwent patenting CEA,and 2 patients(6.1%)underwent CEA+artificial vascular replacement,3 patients(9.1%)with CAS protected by the proximal brain,7 patients(21.2%)with CAS protected by the distal brain,and 1 patient(3.0%)with TCAR.No serious neurological complications occurred after surgery.Symptoms improved or disappeared after 6 months of follow-up.Conclusions For patients with carotid artery stenosis accompanied by severe calcification,CEA is generally the first choice,and attention should be paid to the use of brain protection devices when selecting CAS to reduce the risk of perioperative cerebral infarction.