颈动脉内膜剥脱术患者围手术期颈动脉急性闭塞处理方法的探讨

Preliminary experiences of management on acute carotid artery occlusion during perioperative period of carotid endarterectomy

目的探讨颈动脉内膜剥脱术(CEA)患者围手术期颈动脉急性闭塞的治疗方法及预后。方法回顾性分析徐州医科大学附属连云港医院2017年1月至2021年12月112例因颈动脉狭窄行CEA治疗患者的临床资料。患者术后6~9个月进行随访,采用格拉斯哥预后评分(GOS)评估恢复情况,并行头颈部CT血管造影(CTA)检查。结果112例患者中5例发生围手术期颈动脉急性闭塞,其中术中颈内动脉闭塞1例,颈内动脉合并颈外动脉急性闭塞1例,均予以重新缝合后,多模式监测示颈动脉血管通畅;术中颈外动脉闭塞2例,未重新剪开缝合;1例术中监测未见异常,术后出现对侧肢体偏瘫,肌力1级,颈部血管多普勒超声示术侧颈内动脉闭塞,CT和CTA示局灶性脑梗死,术侧颈总动脉闭塞,予以药物及神经康复治疗。随访结果:GOS 5分4例,4分1例;1例偏瘫患者对侧肌力恢复至4级;头颈部CTA检查示颈总动脉闭塞1例,其余4例未见明显异常。结论CEA术中多模式血流动力学监测可及时发现术中颈动脉急性闭塞,采取积极有效的处理方法可使闭塞颈内动脉再通,能有效防止术后缺血性脑卒中的发生,改善预后。

ObjectiveTo investigate the treatment and prognosis of acute carotid artery occlusion during perioperative period of carotid endarterectomy(CEA).MethodsThe clinical data of 112 carotid artery stenosis patients who underwent CEA from January 2017 to December 2021 in Lianyungang Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed.The patients were followed up at 6 to 9 months after surgery,the clinical prognosis was evaluated by Glasgow outcome score(GOS),and the head and neck CT angiography(CTA)was performed.ResultsAmong the 112 patients,5 patients underwent acute carotid artery occlusion during the perioperative period,including 1 case of intraoperative acute occlusion of internal carotid artery and 1 case of intraoperative internal carotid artery combined with external carotid artery cute occlusion,both of them were re-sutured,and multi-mode monitoring showed that each carotid artery was unobstructed;2 cases of intraoperative external carotid artery occlusion,no re-suture was performed during the operation;1 case of intraoperative monitoring showed no obvious abnormality,and the contralateral limb hemiplegia was observed after surgery,and the muscle strength was grade 1,the carotid color Doppler ultrasound showed the occlusion of the internal carotid artery on the operation side.The CT and CTA examination showed focal infarction and common carotid artery on the operation side,and drugs and conservative treatment were given.The follow-up result:GOS 5 scores was in 4 cases,and 4 scores in 1 case;the muscle strength of hemiplegia patient recovered to grade 4;head and neck CTA examination,except for 1 case of common arterial occlusion,the other 4 cases showed no special abnormality.ConclusionsIntraoperative acute carotid artery occlusion can be detected timely by intraoperative multi-mode hemodynamic monitoring during CEA.Vascular recanalization after acute occlusion is possible by adopting active and effective treatment methods,the occurrence of postoperative ischemic stroke can be effectively prevented and the prognosis of patients can be improved.