复合手术治疗慢性颈内动脉闭塞初步应用及临床效果

Hybrid operation for the treatment of chronic internal carotid artery occlusion: preliminary application and clinical effect

目的探讨颈动脉内膜剥脱术(CEA)联合颈动脉支架成形术(CAS)治疗慢性颈内动脉闭塞病变的初步应用及临床效果。方法回顾性分析2016年2月至2017年12月采用复合手术治疗的23例颈内动脉完全闭塞患者临床资料。所有患者均经全脑血管造影证实颈内动脉完全闭塞。CEA联合CAS术后严格随访,影像学检查评估重建血管再狭窄率、再次脑卒中率、改良Rankin量表(mRS)评分和美国国立卫生研究院卒中量表(NIHSS)评分变化,初步分析手术安全性和有效性。结果颈内动脉闭塞开通成功18例。随访期复查造影显示再狭窄率为16.7%(3/18),再次脑卒中率较低为11.1%(2/18),总体mRS评分和NIHSS评分显著下降。结论复合手术作为颈内动脉闭塞治疗的新兴术式,可治疗传统手术方式无法完成的颈内动脉病变,具有良好疗效。

Objective to evaluate the clinical application and curative effect of carotid endarterectomy(CEA)combined with carotid artery stenting(CAS)in treating chronic internal carotid artery occlusive diseases.Methods The clinical data of a total of 23 patients with complete occlusion of internal carotid artery,who were admitted to the First Affiliated Hospital of Soochow University,China,during the period from February 2016 to December 2017 to receive hybrid operation,were retrospectively analyzed.Complete occlusion of internal carotid artery was confirmed by whole cerebral angiography in all patients.CEA combined with CAS was carried out,and strict postoperative follow-up was implemented in all patients.Imaging examination was used to assess the restenosis rate of reconstructed vessels,incidence of secondary stroke was documented,modified Rankin Scale(mRS)score and National Institutes of Health Stroke Scale(NIHSS)score were calculated,and both the safety and the effectiveness of the hybrid operation were preliminarily analyzed.Results Successful re-canalization of internal carotid artery occlusion was achieved in 18 patients.During the follow-up period,reexamination of angiography showed that restenosis rate was16.7%(3/18),and the incidence of secondary stroke was 11.1%(2/18).The overall mRS score and NIHSS score were significantly decreased.Conclusion As a newly-developed surgical mode for internal carotid artery occlusion,hybrid operation is able to accomplish some specific and complicated internal carotid artery diseases,which usually can’t be cured by conventional surgery alone,and hybrid operation has satisfactory clinical curative effect.