摘要
目的初步探讨复合手术治疗慢性症状性颈内动脉闭塞的可行性和安全性。方法回顾性收集聊城市脑科医院神经外科自2016年4月至2018年12月采用颈动脉内膜剥脱术(CEA)+透视下双腔Fogarty球囊导管(3F)取栓术(必要时予支架植入)治疗的9例慢性症状性颈内动脉闭塞(均经数字减影血管造影检查证实为颈内动脉起始处节段性闭塞)患者的临床资料,分析其血管再通情况及围手术期、随访期并发症发生情况。结果采用CEA+双腔Fogarty球囊导管(3F)取栓治疗5例,取栓后再行支架植入治疗4例。术后颈内动脉即刻通畅9例。术后30 d内3例发生脑过度灌注综合征,给予严格控制血压、适当脱水后症状逐步缓解;9例患者均无脑出血、脑梗死、神经功能损伤等严重并发症发生。术后随访4~36个月,无新发脑梗死或死亡患者,未出现再闭塞情况;1例出现支架内轻度狭窄(50%),无明显相关症状,继续药物治疗;1例术后半年出现1次短暂性脑缺血发作。结论复合手术是治疗慢性症状性颈内动脉闭塞的有效方法,但术前需要进行全面的评估,谨慎地选择患者,制定个体化的治疗方案。
Objective To investigate the feasibility and safety of hybrid surgery in treatment of chronic symptomatic internal carotid artery occlusion.Methods From April 2016 to December 2018,9 patients with chronic symptomatic internal carotid artery occlusion confirmed by digital subtraction angiography were treated with carotid endarterectomy(CEA)+double chamber Fogarty balloon(3F)embolectomy or stent implantation when necessary.The clinical data of these patients were retrospectively analyzed.Vascular recanalization and complications during perioperative period and follow-up of the patients were analyzed.Results CEA+double chamber Fogarty balloon(3F)thrombectomy was performed in 5 patients;and stent placement was performed in 4 patients after Fogarty balloon thrombectomy.The internal carotid arteries of all 9 patients were unobstructed immediately during the operation.Postoperative hyperperfusion syndrome occurred in 3 patients;blood pressure was strictly controlled and the symptoms gradually relieved after proper dehydration.No serious complications such as cerebral hemorrhage,cerebral infarction,or nerve injury occurred.The duration of follow-up was 4-36 months;no patient developed a new stroke or death;no re-occlusion appeared;but one mild restenosis(50%)was detected.one patient suffered from a TIA attack 6 months after operation.Conclusion Hybrid surgery is an effective method for treatment of chronic symptomatic internal carotid artery occlusion;however,preoperative evaluation and selection of patients should be carefully;individualized treatment plans should be developed.
作者
郝继恒
张萌
刘超
王子栋
刘卫东
林凯
王继跃
张利勇
Hao Jiheng;Zhang Meng;Liu Chao;Wang Zidong;Liu Weidong;Lin Kai;Wang Jiyue;Zhang Liyong(Department of Neurosurgery,Liaocheng Brain Hospital,Liaocheng 252000,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2019年第11期1091-1097,共7页
Chinese Journal of Neuromedicine
基金
国家"十三五"重大科技专项课题(2015BAI12B04)。
