Abstract:

Objective: To evaluate and compare the efficacy and safety of endovascular treatment alone versus hybrid operation in the treatment of symptomatic chronic internal carotid artery occlusion (CICAO). Methods: A total of 103 patients with symptomatic CICAO who underwent hybrid operation (n = 60) or endovascular treatment alone (n = 43) in Qilu Hospital of Shandong University from May 2016 to March 2025 were included. All cases were classified into 4 types, namely type A, type B, type C and type D by preoperative DSA examination combined with Hasan classification. The vascular recanalization success rate, as well as the incidence of complications during the perioperative period, follow-up period and in the vascular recanalization cases were recorded. Results: The vascular recanalization success rate of the hybrid operation group was higher than that of the endovascular treatment alone group (χ² = 10.885, P = 0.001). Analysis by Hasan classification showed that Hasan type C had more advantages with hybrid operation (Fisher's exact probability: P = 0.024). There was no statistically significant difference in the incidence of perioperative complications between the hybrid operation group and the endovascular treatment alone group (χ² = 0.008, P = 0.928). The median follow - up time of the hybrid operation group was 33.00 (11.25, 52.75) months, and the median follow-up time of the endovascular treatment alone group was 24 (15, 30) months. During the follow - up period, there were no statistically significant differences in mortality (Fisher's exact probability: P = 1.000), the incidence of new transient ischemic attack/ischemic stroke (Fisher's exact probability: P = 0.251), and the incidence of restenosis/reocclusion of the affected internal carotid artery in vascular success recanalization cases (Fisher's exact probability: P = 0.210). Conclusions: For patients with CICAO, hybrid operation achieves a higher vascular recanalization success rate. This surgical approach is both safe and feasible, and may be particularly beneficial for patients with more complex anatomical features (Hasan type C). There were no significant differences between hybrid operation and endovascular treatment alone in terms of safety and the incidence of postoperative restenosis/reocclusion of affected internal carotid artery.

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

摘要：

目的: 对比分析单纯血管内治疗与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: 纳入2016年5月至2025年3月在山东大学齐鲁医院接受复合手术（复合手术组, 60例）或单纯血管内治疗（单纯血管内治疗组, 43例）的103例症状性慢性颈内动脉闭塞患者, 根据术前DSA检查结合Hasan分型分为A型、B型、C型、D型共4种类型。记录血管再通率以及围手术期、随访期间和血管再通病例中并发症发生率。结果: 复合手术组血管再通率高于单纯血管内治疗组（χ² = 10.885, P = 0.001）, 其中Hasan分型C型采用复合手术更具优势（Fisher确切概率法: P = 0.024）。复合手术组与单纯血管内治疗组围手术期并发症（χ² = 0.008, P = 0.928）、随访期间死亡（Fisher确切概率法: P = 1.000）以及血管再通病例中新发短暂性脑缺血发作或缺血性卒中（Fisher确切概率法: P = 0.251）和同侧颈内动脉再狭窄或再闭塞发生率（Fisher确切概率法: P = 0.210）差异均无统计学意义。结论: 对于症状性慢性颈内动脉闭塞患者, 复合手术治疗在血管再通方面更具优势, 复合手术与单纯血管内治疗在安全性和术后同侧颈内动脉再狭窄或再闭塞方面无显著差异。

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