摘要：

目的 探讨慢性颈内动脉闭塞复合手术再通治疗的有效性和安全性。方法与结果 对2017 年 9 月至 2018 年 9 月行颈动脉内膜切除术联合颈动脉支架成形术的 8 例慢性颈内动脉闭塞患者的临床资料、影像学及随访资料进行回顾分析。结果显示，所有患者均实现闭塞血管再通、颅内血流改善、临床症状好转，仅1例术后24 h MRI可见点状新鲜梗死灶但无临床症状，3例出现同侧舌下神经、喉上神经、面神经下颌缘支损伤症状，术后 2 周自行恢复。术后 3 和 6 个月影像学检查均未见明显异常。结论 颈动脉内膜切除术联合颈动脉支架成形术的复合手术实现闭塞的颈内动脉再通安全、有效。

关键词: 动脉闭塞性疾病, 颈内动脉, 颈动脉内膜切除术, 血管成形术, 支架

Abstract:

Objective To investigate the efficacy and safety of hybrid surgery on revascularization of chronic internal carotid artery occlusion. Methods and Results Eight cases of chronic internal carotid artery occlusion underwent hybrid surgery in our medical center during September 2017 to September 2018 were analyzed retrospectively. Assessment preoperative, surgical procedure, surgical complication and prognosis including clinical data, lab examination, imaging findings during the follow-up period were recorded. All 8 patients underwent hybrid surgery [carotid endarterectomy (CEA) + carotid arterystenting (CAS)]. The revascularization of 8 patients was successful. The intracranial blood flow improvement was confirmed by carotid artery ultrasound, transcranial Doppler (TCD), CTP or PWI and DSA. Brain MRI ofone patient within 24 h postoperation showed visible spotted fresh infarction with no clinical symptoms, and 3 patients occurred ipsilateral cranial nerve injury symptoms (hypoglossal nerve, superior laryngeal nerve and mandibular branch of facial nerve) at postoperation, which were recovered in 2 weeks. All patients had no postoperative cerebral hyperperfusion. Imaging study showed the revascularization was successful and intracranial perfusion was improved at 3 and 6 months during the follow-up. Conclusions Hybrid surgery (CEA + CAS) is safe and effective for carotid artery occlusion.

Key words: Arterial occlusive diseases, Carotid artery, internal, Endarterectomy, carotid, Angioplasty, Stents