颈动脉内膜剥脱术联合腔内技术治疗慢性颈内动脉长段闭塞临床观察

Clinical observation of carotid endarterectomy combined with endovascular technology in treatment of chronic long segment internal carotid artery occlusion

目的观察颈动脉内膜剥脱术联合腔内技术治疗慢性颈内动脉长段闭塞的临床效果。方法颈内动脉长段闭塞患者21例,均采用颈动脉内膜剥脱术联合腔内技术(Fogarty导管取栓、闭塞段球囊扩张、支架置入)治疗。观察围术期一般情况。通过临床症状改善情况及脑血流动力学指标(脑血流量、脑血容量、脑血流平均通过时间)(采用CT灌注成像检测)评价术后效果。术后3、6、12、24个月,采用影像学检查评估颈内动脉通畅情况;术前、术后3个月,采用改良Rankin量表(mRS)评分评价神经功能缺损情况和残障程度。结果 21例患者均成功开通闭塞血管,围手术期无新发脑梗死或死亡,并发症发生率为19.04%。术后临床症状均得到不同程度缓解。与术前比较,术后脑血流动力学指标脑血流量、脑血容量均升高,脑血流平均通过时间缩短(t分别为13.86、3.96、11.98,P均<O.05)。16例(76.19%)获得影像学随访的患者中,13例(81.25%)管腔通畅,1例出现靶血管支架内闭塞,2例出现靶血管狭窄。术后3个月mRS评分2分者3例,1分者5例,0分者13例,提示总体神经功能恢复良好。结论颈动脉内膜剥脱术联合腔内技术是治疗慢性颈内动脉长段闭塞的有效手段,短期随访结果满意,安全性好。

Objective To observe the clinical effect of carotid endarterectomy combined with endovascular technology in the treatment of chronic long segment internal carotid artery occlusion.Methods Twenty-one patients with long segment internal carotid artery occlusion were treated by carotid endarterectomy combined with endovascular technology(Fogarty catheter thrombectomy,balloon expansion of long segment,and stent placement).The clinical symptoms were observed after operation.CT perfusion imaging was used to detect cerebral hemodynamics(cerebral blood flow,cerebral blood volume,and cerebral blood mean transit time)before and one week after surgery.Imaging examination was used to evaluate the internal carotid artery patency at 3,6,12,and 24 months after surgery.The modified Rankin scale(mRS)score was used to evaluate the neurological deficits and disability before and 3 months after surgery.Results All patients were successfully recanalized,with no new stroke or death during peroperative period;the complication rate was 19.04%.The postoperative clinical symptoms were all relieved.Compared with the preoperative indicators,the postoperative cerebral hemodynamics indicators,such as cerebral blood flow and cerebral blood volume increased and the average transit time of cerebral blood flow was shortened(t=13.86,3.96,and 11.98,respectively;all P<0.05).Of the 16 patients(76.19%)who got imaging follow-up,13(81.25%)had luminal patency,1 had target vessel stent occlusion,and 2 had target vessel stenosis.Three months after operation,the mRS score was 2 points in 3 cases,1 point in 5 cases,and 0 point in 13 cases,indicating that the overall neurological function recovered well.Conclusion The carotid endarterectomy combined with endovascular technology is an effective method in the treatment of chronic internal carotid artery occlusion,with satisfactory short-term follow-up results,and safety.