闭塞节段对慢性颈内动脉闭塞血管再通治疗的影响

doi:10.3969/j.issn.1672-6731.2020.06.006

摘要/Abstract

摘要：

目的探讨闭塞节段对慢性颈内动脉闭塞患者血管再通成功率、再通方式，以及围手术期并发症和预后的影响。方法共39例慢性颈内动脉闭塞患者均为2017年1月至2020年1月接受血管再通治疗的连续病例，采集患者一般资料、血管再通率、并发症及随访信息，比较不同闭塞节段的疗效、安全性与预后差异。结果 30例（76.92%）患者血管再通成功，其中颅外短节段闭塞（C1段、C1~C2段或C1~C3段）、中节段闭塞（C1~C4段）、长节段闭塞（C1~C5或C1~C6段）和颅内短节段闭塞（C6段或C6~C7段）的血管再通成功率分别为9/11、8/10、9/14和4/4；7例（23.33%）行单纯球囊扩张术、15例（50%）行单纯支架植入术、8例（26.67%）行球囊扩张术联合支架植入术，其中颅外短节段闭塞、中节段闭塞、长节段闭塞和颅内短节段闭塞行单纯球囊扩张术的比例分别为0/9、1/8、3/9和3/4，行单纯支架植入术的比例分别为9/9、4/8、1/9和1/4；围手术期并发症未显示出明显的闭塞节段相关性。1例（3.33%）死亡；29例随访16（4，27）个月，仅1例（3.45%）发生再通侧小卒中。21例获5.50（3.50，8.00）个月的影像学随访，动脉再狭窄2例、动脉再闭塞3例，均为中长节段闭塞再通患者。结论血管再通治疗对不同闭塞节段的慢性颈内动脉闭塞相对安全、有效，围手术期风险较低，长节段闭塞血管再通成功率较低、更倾向单纯球囊扩张术、动脉再狭窄或再闭塞发生率较高。

关键词: 动脉闭塞性疾病, 颈内动脉, 血管成形术, 手术中并发症

Abstract:

Objective To explore whether occlusion site affects success rate, methods of recanalization, perioperative complications, and prognosis of recanalization in chronic internal carotid artery occulsion (CICAO). Methods Thirty-nine patients diagnosed as CICAO from January 2017 to January 2020, and treated by endovascular recanalization were retrospectively reviewed. Baseline information, endovascular procedures, complications, clinical and angiographic prognosis were collected. Effects of occlusion site were analyzed. Results Thirty patients (76.92%) achieved successful endovascular recanalization. Successful recanalization rates varied among groups with different occlusion sites of extracranial short segment (C1, C1-C2 or C1-C3), medium segment (C1-C4), long segment (C1-C5 or C1-C6) and intracranial short segment (C6 or C6-C7) were 9/11, 8/10, 9/14 and 4/4, respectively. Sole angioplasty with balloon was applied in 7 patients (23.33%), sole stenting in 15 (50%), angioplasty with balloon and stents in 8 (26.67%). Among different occlusion sites of extracranial short, medium, long segment and intracranial short segment, sole angioplasty with balloon was applied in 0/9, 1/8, 3/9 and 3/4; while sole stenting was applied in 9/9, 4/8, 1/9 and 1/4. Procedure-related complications were not related with occlusion site. One patient (33.33%) died, while 29 surviving patients during a median clinical follow-up of 16 (4, 27) months with successful recanalization, only one (3.45%) developed ipsilateral minor stroke due to restenosis. With a median angiographic follow-up of 5.50 (3.50, 8.00) months, 2 restenosis and 3 reocclusion were found in 21 patients, all of which came from medium and long segment occlusion. Conclusions Endovascular recanalization is feasible and effective in CICAO with relatively low procedure-related complications. However, success rate of recanalization decreases in groups of long segment occlusion. Application of angioplasty methods differs in groups with varying occlusion sites. Procedure-related complications seem relatively low. While, restenosis and reocclusion are mostly found in long segment occlusion.

Key words: Arterial occlusive diseases, Carotid artery,internal, Angioplasty, Intraoperative complications

祁鹏, 尹晓亮, 陆军, 胡深, 王俊杰, 杨希孟, 陈鲲鹏, 王海峰, 王大明. 闭塞节段对慢性颈内动脉闭塞血管再通治疗的影响[J]. 中国现代神经疾病杂志, 2020, 20(6): 496-502.

QI Peng, YIN Xiao-liang, LU Jun, HU Shen, WANG Jun-jie, YANG Xi-meng, CHEN Kun-peng, WANG Hai-feng, WANG Da-ming. Effect of occlusion site on endovascular recanalization of chronic internal carotid artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 496-502.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I6/496

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Effect of occlusion site on endovascular recanalization of chronic internal carotid artery occlusion

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