Abstract:

Objective: To explore the efficacy and safety of multimodal image - guided hybrid operation in the treatment of symptomatic chronic internal carotid artery occlusion (CICAO). Methods and Results: Total 25 patients with symptomatic CICAO who underwent hybrid operation in Tianjin Huanhu Hospital from July 2018 to August 2023 were enrolled. All patients completed preoperative multimodal imaging examinations, including cervical vascular ultrasound, transcranial Doppler ultrasonography (TCD), CTA or DSA, CT perfusion imaging (CTP) or perfusion -weighted imaging (PWI), and high -resolution MRI (HRMRI). Carotid endarterectomy (CEA) combined with endovascular treatment was performed in the hybrid operating room. Vascular recanalization was successfully achieved in all patients after surgery, with a success rate of 100% (25/25). One day after surgery, 25 patients underwent head CT, and one had intraoperative subarachnoid hemorrhage. Within 7 d after surgery, 24 patients underwent CTP or PWI, all of which showed improved perfusion flow compared with preoperation. Within 7 d after surgery, 25 patients underwent head MRI, and 4 had cerebral infarction. Within 7 d after surgery, 24 patients underwent cervical vascular ultrasound or TCD, all of which showed patency of the internal carotid artery (ICA). The mean National Institutes of Health Stroke Scale (NIHSS) scores at discharge, 6 months and one year after surgery were 3.36, 2.72 and 2.72; the mean modified Rankin Scale (mRS) scores were 0.76, 0.60 and 0.60. The perioperative complication rate was 20% (5/25). The average follow-up time was 24.88 months, and the affected ICA restenosis rate was 16% (4/25); no patient had reocclusion of the affected ICA. Conclusions: Multimodal image - guided hybrid operation is technically feasible and safe and effective in clinical application, providing a new treatment option for symptomatic CICAO.

Key words: Carotid artery thrombosis, Carotid artery, internal, Endarterectomy, carotid, Saccule and utricle, Stents, Multimodal imaging

摘要：

目的: 探讨多模态影像引导的复合手术治疗症状性慢性颈内动脉闭塞的有效性和安全性。方法与结果: 纳入2018年7月至2023年8月在天津市环湖医院行复合手术的25例症状性慢性颈内动脉闭塞患者, 均于术前完善多模态影像学检查, 包括颈部血管超声、经颅多普勒超声（TCD）、CTA或DSA、CT灌注成像（CTP）或灌注成像（PWI）、高分辨率MRI, 并在复合手术室行颈动脉内膜切除术+ 血管内治疗。术后所有患者均实现血管再通, 手术成功率为100%（25/25）。术后第1天25例患者行头部CT检查, 1例术中发生蛛网膜下腔出血。术后7 d内, 24例患者行CTP或PWI检查, 脑灌注较术前均有所改善; 25例患者行头部MRI检查, 4例存在脑梗死; 24例患者行颈部血管超声或TCD检查, 颈内动脉均血流通畅。出院时、术后6个月和1年平均美国国立卫生研究院卒中量表评分为3.36、2.72和2.72分, 平均改良Rankin量表评分为0.76、0.60和0.60分。围手术期并发症发生率为20%（5/25）; 平均随访24.88个月, 同侧颈内动脉再狭窄率为16%（4/25）, 均未发生同侧颈内动脉再闭塞。结论: 多模态影像引导的复合手术技术可行, 且临床应用具有良好疗效和安全性, 为症状性慢性颈内动脉闭塞提供新的治疗选择。

关键词: 颈动脉血栓形成, 颈内动脉, 颈动脉内膜切除术, 球囊和椭圆囊, 支架, 多模态成像