颅外颈动脉瘤40例的诊断和治疗

目的探讨颅外颈动脉瘤的诊断与手术治疗方法。方法回顾性总结１９５３～１９９７年收治的４０例颅外颈动脉瘤的诊疗经验。结果４０例患者分别经动脉造影、数字减影血管造影（ｄｉｇｉｔａｌｓｕｂｓｔｒａｃｔｉｏｎａｎｇｉｏｇｒａｐｈｙ，ＤＳＡ）、超声波以及ＣＴ、磁共振血管成像（ｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅａｎｇｉｏｇｒａｐｈｙ，ＭＲＡ）确诊。手术治疗３５例，其中动脉瘤切除后颈动脉重建１８例次，近远端动脉结扎１６例，颈总动脉结扎１例，行外包裹术１例，围手术期死亡１例。结论颈动脉血管造影术是诊断颅外颈动脉瘤最有效的手段，动脉瘤切除近远端动脉结扎和动脉瘤切除血管吻合或移植术是选择的主要术式     

颅外颈动脉瘤的诊断和治疗

探讨颅外颈动脉瘤的诊断和治疗方法。方法对１２例颅外颈动脉瘤的治疗进行回顾性总结。结果颈总脉瘤９例，颈内动脉瘤３例，均经手术治疗。其中动脉瘤切除，颈内动脉重建术１１例；动脉瘤包裹术１例。术中未用内转流。手术并发症１例，无手术死亡。     

颈动脉体瘤8例报告

颈动脉瘤少见难治，１９９６年３～１１月内收治１２个瘤体。其中双侧病变４例（５０％），３例属同一家族（一男二女，为亲兄妹）。对６例８个瘤体施行了切除，除１例术后有短期吞咽困难外无并发症。认为：对本病应争取采用瘤体剥脱术，其次为瘤体与颈外动脉同时切除，当颈动脉明显受累时，应采取颈总动脉重建分叉与瘤体切除和颈动脉重建法；应力求避免结扎颈总和颈内动脉；当需重建动脉时，我们提倡先重建动脉，后切除瘤体；对巨大或紧贴颅底者，可在施行近侧动脉吻合后，横断瘤体，自断面上显露颈内动脉开口，完成吻合，最后便可从容地切除瘤体。     

血管内栓塞结合显微手术治疗颅内动脉瘤临床研究

目的应用显微手术夹闭、血管内栓塞和栓塞后手术夹闭3种治疗方法，探讨治疗颅内破裂动脉瘤的安全有效方案。方法显微手术瘤颈夹闭30个动脉瘤，栓塞34个动脉瘤，栓塞后夹闭15个动脉瘤。结果夹闭组30个完全夹闭，无复发，死亡率6％（2／30）。栓塞组完全闭塞率70．6％（24／34），复发率17．6％（6／34），死亡率11．8％（4／34）。栓塞后手术组15个完全夹闭，无复发，死亡率6．7％（1／15）。治疗结束用GOS评价，1个月后3组良好率分别为80．0％、79．4％和80．0％；半年后良好率分别为90．0％、88．2％和86．7％。结论显微手术瘤颈夹闭术仍然是治疗破裂动脉瘤的有效方法，具有1次治疗彻底和复发率低的优势，并可作为栓塞失败的补救手段。     

颈动脉体瘤外科治疗中颅神经和脑血管并发症的防治体会

本文报道３６例共３７例侧颈动脉体瘤，肿瘤局限于颈动脉分叉部９例，包绕颈内动脉２例，包绕颈外动脉８例，同时累及颈内，颈外动脉及颈总动脉分叉部１８例，在无颈动脉内转流条件下行３７例手术，其中单纯肺瘤切除术２２例，肿瘤宫同部分颈内，颈外动脉及颈总动脉分叉部切除，自体大隐静脉移植术１５例，手术死亡占８．１％，但１９８３年以后无１例死亡，发生颅神经损伤占４３．２％，肿瘤转移占２．８％，本文表明近１０年来颈动     

颈动脉体瘤的诊断和治疗(附26例报告)

我科１９８８年１１月至１９９７年１０月９年间共收治颈动脉体瘤患者２６例（２７个）,其中１１例在外院被误诊,入院后２６例均行Ｂ超检查,其中１８例行颈动脉造影检查。２６例中行低温（３０℃～３２℃）麻醉１７例,应用Ｓｈｕｎｔ９例（１０个）;２７个肿瘤均一期切除,其中行单纯瘤体剥除８例（９个）,瘤体连同颈外动脉一同切除３例;瘤体连同部分颈内动脉、颈外动脉及颈总动脉一并切除后行颈动脉搭桥重建术１１例,颈总动脉颈内动脉吻合２例,颈内动脉结扎术２例。结果除１例术后发生偏瘫外,其余效果均良好。笔者认为,仔细的体检,结合超声波和颈动脉造影检查是诊断颈动脉体瘤,防止误诊的重要方法;低温全身麻醉和术中颈总动脉颈内动脉分流是保护脑组织的重要措施     

颅外颈动脉病65例报告

目的:为提高颅外血管病变的认识和诊治水平.方法:总结我院1986年以来主要颅外血管病,其中窃血综合征30例,颅外动脉瘤12例,颈动脉狭窄20例和其他颈动脉畸形3例,共65例.行颈动脉-锁骨下动脉旁路术25例,腋-腋人工血管旁路术3例,颈动脉内膜剥脱术20例,颈动脉瘤切除再建术12例,主动脉-颈总动脉、双肱动脉人工血管旁路术3例,颈动脉成形术2例.结果:术后症状明显改善,头晕缓解60%,视力改善75%,双上肢脉压差减少92.8%,TIA消失100%.无偏瘫及手术死亡率.随访2月～10年,症状未改善2例,脑梗塞1例,移植血管阻塞2例. 结论:本文认为颅外血管病变应手术治疗,手术效果好.重视术前Matas试验,使术中颈内动脉返压达6.67kPa(50mmHg)以上,不必转流.     

大脑中动脉瘤的显微外科治疗

目的：报道３４例大脑中动脉瘤显微外科手术的经验。方法：３４中１例有２个动脉瘤，共计３５个动脉瘤，其中大和巨型动脉瘤１４个（４０％），除２个大脑中动脉主干棱形动脉瘤行动脉瘤包裹，２个巨型动脉瘤行Ｍ１阻断伴颅内外动脉吻合外，其余（８８％）均做动脉瘤颈夹闭或动脉瘤切除。结果：无手术死亡，２例术后发生神经缺失。平均随访６年，优良率达９３．８％。结论：显微外科手术治疗大脑中动脉瘤，成功率高，效果好，该项技术值得推广应用。     

颅外颈动脉瘤的外科治疗(附62例报告)

颅外颈动脉瘤的外科治疗（附６２例报告）中国医科大学第一临床学院（沈阳，１１０００１）辛世杰段志泉张强张荣义董雨亭颅外颈动脉瘤（ｅｘｔｒａｃｒａｎｉａｌｃａｒｏｔｉｄａｒｔｅｒｙａ－ｎｅｕｒｙｓｍ，ＥＣＡＡ）仅占外周动脉瘤的２％［１］，该病一经确诊如不...     

颅外段颈动脉瘤和颈动脉扩张症29例治疗体会

1 临床资料 1986～1997年期间,治疗颅外段颈动脉瘤和颈动脉扩张症29例,其中男性11例,女性18例。发病年龄6～72岁,平均47.6岁。本组包括假性动脉瘤5例(2例为双侧,均有附壁血栓),颈动脉恶性血管内皮肉瘤1例,颈总动脉瘤2例(1例伴附壁血栓),颈外动脉瘤2例,颈内动脉瘤3例,颈动脉分叉部扩张症16例(2例为双侧,伴附壁血栓者1例)。术前伴脑神     

Endovascular repair of an extracranial carotid artery aneurysm complicated by late stent thrombosis

Abstract

Extracranial carotid artery aneurysms (ECAA) are extremely rare, accounting for less than 1% of all peripheral artery aneurysms. The most common presentation is central neurologic dysfunction, typically due to embolization of thrombus from the aneurysm. Historically open surgical intervention is the treatment of choice for symptomatic ECAA. Recent data suggest that endovascular repair is a valuable alternative, with a high procedural success rate and relatively low complication rate. We present a case of an ECAA with symptoms of vision loss, successfully treated by endovascular covered stenting but complicated by late in stent thrombosis and cerebral infarction. The patient was subsequently treated with IV thrombolysis and life-long warfarin. The patient had discrete residual symptoms at follow-up 3 months later.     

Endovascular Stenting of Extracranial Carotid Artery Aneurysm: A Systematic Review

Objective

The objective of this study was to systematically review all available published data about endovascular stenting for patients with extracranial carotid artery aneurysm (ECAA).

Methods

All clinical reports in the English language on endovascular stenting for ECAA from 1995 through 2010 were identified. General clinical information, aetiology and parameter of carotid artery aneurysm, information regarding devices, indications for endovascular stenting and in-hospital and follow-up data of each patient were extracted individually.

Results

A total of 113 studies, involving a total of 224 patients, were included. Procedure success was reported in 92.8% of patients. Postoperative endoleak was reported in 8.1% of patients. The incidence of stroke was 1.8%. Cranial nerve injury occurred in 0.5%. Overall in-hospital mortality was 4.1%. The mean follow-up was 15.4 ± 15.3 months. Stent-graft patency rate was 93.2%.

Conclusion

Endovascular stenting is technically feasible with high procedure success and relatively low complication rate in patients with ECAA. Both short- and mid-term outcomes appear to be favourable.     

Incidental asymptomatic cerebral aneurysms in patients with extracranial cerebrovascular disease: is this a case against carotid endarterectomy without arteriography?

As less arteriography is performed before carotid surgery, concern arises about missing occult cerebral aneurysms and possible adverse outcomes. A study was conducted by the divisions of vascular surgery and neurosurgery of Northwestern University Medical School to evaluate the frequency of incidental cerebral aneurysms and outcomes of patients with extracranial cerebrovascular disease and asymptomatic cerebral aneurysms. From October 1995, through March 1997, 200 patients underwent intracranial and extracranial cerebrovascular angiography for evaluation of extracranial disease. Demographic data, symptoms, data of vascular lesions, surgical treatment and outcomes of stroke and death were recorded prospectively. Two patients (1%) had asymptomatic cerebral aneurysms found on angiography. Six more patients were referred with a known asymptomatic cerebral aneurysm with extracranial disease during this same period. Of these eight patients, five underwent extracranial vascular reconstruction surgery and seven received treatment for their aneurysms. There were two stroke complications, both occurred after treatment of a basilar artery aneurysm. One of these patients died. No aneurysms ruptured following 203 extracranial revascularizations during this same period. On the basis of the low prevalence of diagnosing coincidental cerebral aneurysms during work-up of extracranial disease, as well as the lack of evidence that carotid surgery predisposes to aneurysm rupture in these patients in both our study and the literature review, it is concluded that coexisting extracranial disease and asymptomatic cerebral aneurysms do not pose a case against carotid surgery without routine arteriography. However, arteriography should be considered in selected groups of patients where the yield of intracranial aneurysms is high; these include patients with a familial history of cerebral aneurysms, autosomal dominant polycystic kidney disease, extracranial internal carotid artery medial fibrodysplasia, Takayasu's arteritis, alpha1-antitripsin deficiency and atypical clinical presentations, including headache.     

A tailored approach to operative repair of extracranial carotid aneurysms based on anatomic types and kinks

Background

To present outcomes following an operative approach of extracranial carotid artery aneurysm (ECAAs) based on anatomic types and associated kinks.

Methods

This study represents retrospective analysis of anatomic type based approach to operative repair of 84 patients with ECAA from 1994 to 2011, 28 (33.3%) with associated kinking. Patients were followed for neurological ischemic events, hematoma, cranial nerve injury, myocardial infarction, neurological, and overall mortality. The results are presented as early, within 30 days after the surgery, and long term during the follow-up.

Results

In the early postoperative period, there were no strokes or mortalities, cranial nerve injury rate was 2.4% while 1 patient had myocardial infarction (1.2%). During the follow-up, 4 patients (4.8%) had stroke, out of which 2 patients died (2.3%), while overall mortality was 4.6%. The average 5-year survival rate was 96 ± 3%.

Conclusion

Excellent outcomes can be obtained with surgical repair of ECAA, which should be tailored to the anatomic types and presence of kinks.     

Aneurysm dissection of the extracranial internal carotid artery

Aneurysm of the extracranial internal carotid artery is a rare event. This is a pathology with an elevated mortality of 70%. The most important etiologic factor is atherosclerosis. Here we report a case of surgically treated extracranial internal carotid artery (ICA) aneurysm. A 77-year-old man noticed a laterocervical pulsatile mass. Color Doppler ultrasonography revealed an ICA aneurysm related to a parietal thrombosis. The ICA aneurysm was confirmed by intra-arterial digital subtraction angiography, and cerebral computer tomography (CT) was negative. Surgical treatment reconstruction with the interposition of a part of the great saphenous vein was indicated. Exploration of the aneurysmatic wall revealed a posterolateral dissection. In this paper are discussed clinical and therapeutic implications.     

Surgical treatment of extracranial internal carotid artery aneurysm

Aneurysms of the extracranial internal carotid artery are rare but can be responsible for severe complications such as rupture, thrombosis, or embolism. Between 1961 and 1985 we operated on 38 aneurysms of the extracranial internal carotid artery in 35 patients, 22 males and 13 females, whose ages ranged from 6 to 73 years. The underlying causes of aneurysm included atherosclerosis (12 cases), fibromuscular dysplasia (eight cases), a congenital defect (five cases), infection (one case), and trauma (six cases); in six cases aneurysm was secondary to spontaneous dissection. Signs of cerebral ischemia were present in 26 (74%) patients and a cervical mass was found in six. The aneurysm was proximal (i.e., below the angle of the mandible) in 16 patients and distal (i.e., above the angle of the mandible) in 22. After resection of the aneurysm, arterial continuity was restored in 37 patients by resection and grafting (12 cases), resection and anastomosis (11 cases), or arteriorrhaphy (14 cases). One death occurred 13 days after operation due to myocardial infarction. Two patients experienced a reversible neurologic event. Transient paresis of cranial nerves was observed in eight patients. During a follow-up period that ranged from 6 to 30 years, four patients were lost to follow-up and 25 patients remained asymptomatic. Three patients had asymptomatic thrombosis of the carotid artery detected at follow-up investigations. The potential risks of cerebral ischemia and rupture and the satisfactory long-term results achieved with surgery are strong arguments in favor of surgical treatment for aneurysms of the extracranial internal carotid artery.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Reims, France, June 19– 20, 1992.     

Die chirurgische Therapie des extrakraniellen Karotisaneurysmas

Background. Aneurysms of the extracranial carotid artery are very rare. Indications for surgical therapeutic intervention, surgical techniques, perioperative complications and long-term results after operative reconstruction during an observation period of 16 years were analyzed. Patient collective. Continuous clinical follow-up of 36 patients (mean age: 60.2 years, range: 30–79 years) who underwent 41 carotid artery reconstructions due to aneurysm of the extracranial carotid arteries between 1980 and 1996. Postoperative investigation included physical and neurological examination and telephone interviews. Clinical symptoms. Fifteen patients presented with pulsatile cervical tumors, 53% of these patients had experienced an episode of cerebral ischemia prior to surgery. Anatomical localization and OP-techniques. Isolated aneurysms of the internal carotid artery (type I, end-to-end anastomosis, interposition, n=14) extensive long distance aneurysms of the internal carotid artery (type II, n=7, interposition), aneurysms of the carotid bifurcation (type III, n=13, direct suture, patch-plasty) combined aneurysm of the internal and common carotid artery (type IV, n=4, interposition), isolated aneurysm of the common carotid artery (type V, n=3, interposition). Postoperative complications. After 3 of 41 carotid reconstructions a cerebral ischemia was encountered (TIA, n=1, PRIND n=1, minor stroke n=1). In nine cases, perioperative cranio-facial nerve palsies were detected. Six nerve palsies were temporary, while three were permanent. Long-term results. One year, 5 years and 10 years after surgery 100%, 94% and 80.8% of the patients are alive and 97.5%, 88.7% and 78.8%, respectively, have not experienced an ipsilateral ischemic stroke. Conclusion. Surgical intervention for extracranial carotid aneurysm is a safe procedure with good long-term results. The risk of a permanent neurological deficit is low (2.4%). Permanent cranio-facial nerve palsies were detected in 7.3% of patients.     

False aneurysm of cervical carotid artery from intraplaque haemorrhage: a case report

A case of non-traumatic extracranial carotid false aneurysm in a patient with carotid atherosclerotic occlusive disease and a recent history of a cerebral ischaemic event but without any history of carotid artery surgery or cervical trauma, is reported.