摘要
目的探讨慢性症状性颈内动脉闭塞患者的闭塞部位对手术再通治疗结果的影响。方法回顾性分析2015年5月至2017年5月河南省人民医院脑血管介入科经血管内治疗或复合手术治疗的45例慢性症状性颈内动脉闭塞患者的临床资料。根据闭塞部位的不同,将45例患者分为Ⅰ型闭塞组(闭塞起始段位于颈段,闭塞远端在海绵窦段及以下,共25例)和Ⅱ型闭塞组(闭塞起始段位于颈段,闭塞远端在床突段及以上,共20例)。比较两组的手术开通成功率和术后再闭塞率。结果45例患者的手术即刻开通成功率为91.1%(41/45),其中Ⅰ型闭塞组的开通成功率为100.0%(25/25),Ⅱ型闭塞组的手术开通成功比例为16/20,两组的差异有统计学意义(χ^2=5.040,P=0.025)。开通成功的41例患者中,40例获临床随访和影像学随访,中位随访时间为12(4~36)个月。Ⅰ型闭塞组无一例发生再闭塞,Ⅱ型闭塞组的再闭塞比例为4/15,两组比较差异有统计学意义(χ^2=8.821,P=0.003)。结论对于慢性症状性颈内动脉闭塞,Ⅰ型闭塞的手术开通成功率高,术后再闭塞率低,通过手术开通治疗可改善患者的预后;Ⅱ型闭塞患者的手术开通成功率相对低,术后再闭塞率高,术前应综合评估以决定手术方式。
Objective To investigate the relationship of chronic occlusion site of internal carotid artery (ICA) to the outcome of recanalization. Methods The patients with chronic symptomatic occlusion of ICA who were treated by endovascular revascularization or hybrid surgery at Cerebrovascular Division of Interventional Therapy Center, Henan Provincial People's Hospital from May 2015 to May 2017 were retrospectively reviewed. According to the location of ICA occlusion, the patients were divided into 2 types: Type Ⅰ occlusion and Type Ⅱ occlusion. Type Ⅰ occlusion was located from cervical segment to the cavernous segment and below, whereas Type Ⅱ occlusion was originated from cervical segment to the clinoidal segment and beyond.Comparison was conducted on the rates of technical success and re-occlusion after operation between Type Ⅰ occlusion and Type Ⅱ occlusion. Results Forty-five patients with chronic symptomatic ICA occlusion had a total technical success rate of 91.1%(41/45). The technical success rate was 100.0%(25/25) in Type Ⅰ occlusion and 80.0%(16/20) in Type Ⅱ occlusion, and the difference was statistically significant (χ^2=5.040, P=0.025). Among the 41 patients who were successfully recanalized, 40 acquired clinical follow-up with a median of 12 months(range: 4-36 months). The rate of re-occlusion was 0%(0/25) in Type Ⅰ occlusion and 26.7%(4/15) in Type Ⅱ occlusion with statistical difference (χ^2=8.821, P=0.003). Conclusions Patients with Type Ⅰ occlusion seem to have high technical success rate and low re-occlusion rate, which can be treated to improve the outcome. Type Ⅱ occlusive patients have relatively low technical success rate whereas high re-occlusion rate, which should be comprehensively evaluated before operation.
作者
时伟玉
薛绛宇
李天晓
赵同源
许岗勤
杨博文
蔡栋阳
贺迎坤
Shi Weiyu;Xue Jiangyu;Li Tianxiao;Zhao Tongyuan;Xu Gangqin;Yang Bowen;Cai Dongyang;He Yingkun(Xinxiang Medical University, Xinxiang 453003, China;Cerebrovascular Division of Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou 450003, China)
出处
《中华神经外科杂志》
CSCD
北大核心
2019年第4期382-386,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(81601583)。
关键词
颈内动脉
动脉闭塞性疾病
血管内手术
复合手术
治疗结果
Carotid artery, internal
Arterial occlusive diseases
Endovascular procedures
Hybrid surgery
Treatment outcome
