慢性颈动脉闭塞的血管再通治疗

doi:10.3969/j.issn.1672-6731.2020.06.007

摘要/Abstract

摘要：

目的总结慢性颈动脉闭塞血管再通治疗的手术体会和围手术期并发症。方法纳入2018年8月至2019年7月共12例慢性颈动脉闭塞患者，均行血管再通治疗，术前通过多模态影像学方法评估闭塞部位、闭塞节段、闭塞近端残端形态和血管壁病变性质，并记录围手术期并发症。结果共10例患者实现血管再通，成功率为10/12；2例血管再通失败病例，分别为累及岩骨段以上的长节段动脉夹层（1例）和闭塞近端残端呈钝头型（1例）。6例患者发生围手术期并发症包括术中栓子脱落（3例）、术中血管痉挛（1例）、术后脑高灌注综合征（1例）和术后严重低血压（1例）。结论累及岩骨段以上的长节段闭塞、闭塞近端残端形态和血管壁病变性质均可能影响血管再通成功率，栓子脱落、脑血管痉挛、脑高灌注综合征和低血压是主要的围手术期并发症。

关键词: 动脉闭塞性疾病, 颈动脉疾病, 血管成形术, 球囊和椭圆囊, 支架, 手术中并发症

Abstract:

Objective To summarize the experiences and perioperative complications of endovascular recanalization in chronic carotid artery occlusion (CCAO). Methods A total of 12 patients with CCAO were included from August 2018 to July 2019, who were all treated with endovascular recanalization. The occlusive site, occlusive segment, occlusive proximal stump morphology and the nature of the lesion were evaluated by multimode imaging, and perioperative complications were recorded. Results Ten patients were successfully operated, the success rate of endovascular recanalization was 10/12. Two patients had failed in surgery, including one patient with long segment artery dissection above the petrous bone segment and one patient with blunt stump. Perioperative complications occurred in 6 patients, including 3 cases of intraoperative embolus shedding, one case of intraoperative vasospasm, one case of postoperative cerebral hyperperfusion syndrome (CHS), and one case of postoperative severe hypotension. Conclusions The long segment lesion above the petrous bone segment, the shape of the stump and the nature of lesion may affect the success rate of endovascular recanalization. Embolus detachment, vasospasm, CHS and hypotension are the main perioperative complications.

Key words: Arterial occlusive diseases, Carotid artery dieseases, Angioplasty, Saccule and utricle, Stents, Intraoperative complications

吴祥波, 蔡权, 黄子纯, 康志明, 聂创, 孙冬, 李华钢, 刘煜敏, 梅斌. 慢性颈动脉闭塞的血管再通治疗[J]. 中国现代神经疾病杂志, 2020, 20(6): 503-511.

WU Xiang-bo, CAI Quan, HUANG Zi-chun, KANG Zhi-ming, NIE Chuang, SUN Dong, LI Hua-gang, LIU Yu-min, MEI Bin. Endovascular recanalization for chronic carotid artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 503-511.

https://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I6/503

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Endovascular recanalization for chronic carotid artery occlusion

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