颈动脉内膜剥脱术治疗颈动脉狭窄

目的 探讨颈动脉内膜剥脱术的适应证及手术操作要点.方法 回顾性总结12例因短暂性脑缺血伴有颈动脉硬化狭窄患者行颈动脉内膜剥脱术的,临床资料.结果 所有患者的短暂性脑缺血表现消失.部分患者慢性脑缺血症状也得到明显改善.术后1例出现一过性神志模糊,1例出现高血压,2例出现伤口轻度肿胀,治疗后均康复出院.术后未出现偏瘫或脑出血等严重并发症.结论 对于短暂性脑缺血病人(TIA),经Doppler超声或数字减影动脉造影术(DSA)检查发现颈总动脉或颈内动脉狭窄＞60%者,可以考虑行颈动脉内膜剥脱术(CEA).对于双侧颈动脉狭窄者,分期手术治疗较为安全.     

颈动脉内膜剥脱术治疗颈动脉狭窄60例临床分析

目的 探讨颈动脉内膜剥脱术治疗颈动脉狭窄的疗效及安全性.方法 回顾性分析新疆维吾尔自治区人民医院血管外科2009年1月-2013年12月行颈动脉内膜剥脱术治疗颈动脉狭窄的60例患者的临床资料.结果 本组无围手术期死亡病例.术后出现脑出血1例,脑梗死2例,轻度伸舌偏移2例.结论 颈动脉内膜剥脱术是一种安全有效的治疗颈动脉狭窄的手术方式.颈动脉内膜剥脱术关键在于严格掌握手术适应证,提高手术技巧和有效防治并发症.     

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目的分析颈动脉内膜剥脱术后并发症的原因,探讨其防治措施。方法回顾性分析南京大学医学院附属鼓楼医院血管外科收治的因严重颈动脉狭窄行颈动脉内膜剥脱术179例。其中标准式颈动脉内膜剥脱术(SCEA)87例,外翻式颈动脉内膜剥脱术(ECEA)92例。转流管使用35例,均为SCEA术式。结果所有手术操作顺利。围手术期内发生急性颈动脉血栓形成1例、脑梗死2例、脑出血2例、暂时性失读1例、舌下神经损伤1例、声音嘶哑1例、伤口血肿3例。围手术期死亡1例。结论手术指征不严、术中操作失误、术后处理不当是导致相关并发症的主要因素。对于并发症的发生重在预防,发生后必须准确判断、处理迅速。     

置腔内转流管和颈动脉补片行颈动脉内膜剥脱术(附45例报告)

目的探讨颈动脉内膜切除剥脱术(CEA)的手术方法及技巧,以降低围手术期脑卒中发生率及术后再狭窄发生率。方法2001年3月至2005年3月复旦大学附属华山医院血管外科行CEA45例,其中颈动脉硬化单侧狭窄36例、双侧9例。短暂性脑缺血(TIA)32例,缺血性脑卒中7例,无神经系统症状者4例。术前常规行多普勒彩超检查,9例行DSA检查,38例行CTA检查。颈内动脉起始段平均狭窄为(69±12)%。所有病人均在全麻下行CEA,术中常规置颈动脉转流管及用牛心包补片作颈动脉成形术。手术时间平均110min,脑缺血时间平均2min45s。结果围手术期及术后30d均无死亡及脑卒中发生,2例分别于术后6h及10h出现TIA。术后随访6~42个月,均未发生脑卒中。32例TIA病人,28例症状消失,4例症状改善。1例8个月后颈动脉轻度狭窄(<30%),其余病人颈动脉均无再狭窄。结论颈动脉内膜剥脱术中,常规运用颈动脉转流管及常规采用牛心包补片做动脉成形术可使手术更安全有效及减少术后再狭窄的发生。     

颈动脉狭窄患者围手术期脑部并发症的诊治

目的 探讨颈动脉狭窄患者围手术期脑部并发症的原因及其防治措施.方法 回顾性分析2004年5月至2009年6月间接受外科治疗的133例颈动脉狭窄患者围手术期脑部并发症的原因及其处理方式.结果 本组133例颈动脉狭窄患者,其中男97例,女36例;年龄62～78岁,平均(67±8)岁.其中94例接受颈动脉内膜剥脱术(carotid endarterectomy,CEA),39例接受颈动脉支架植入术(carotid artery stenting,CAS);围手术期16例出现脑部并发症,其中3例发病次数在2次以上;术前5例出现短暂性脑缺血发作(transient ischemic attacks,TIA)及一过性脑供血不足等并发症;CEA术中5例、CAS术中4例出现TIA发作和脑过度灌注综合征(cerebral hyperperfusion syndrome,CHPS)等并发症;术后8例患者出现TIA发作、脑过度灌注综合征、脑梗死及脑出血等并发症.结论 有效控制围手术期脑部并发症的发生是外科治疗颈动脉狭窄成败的关健,脑部并发症的防治应贯穿整个围手术期.     

颈动脉内膜剥脱术防治缺血性脑卒中

目的　总结我们行颈动脉内膜剥脱术的经验。方法　本组共 3 6例 ,均为颈动脉粥样硬化狭窄或闭塞 ,其中男 2 9例 ,女 7例。年龄 40～ 82岁 ,平均 61岁。单一侧颈动脉狭窄者 2 6例 ,双侧狭窄者 10例。全部在转流管保护下行颈动脉内膜剥脱。结果　全部病例中均未发生脑缺血并发症 ,仅 2例行内膜剥脱术后局部再次狭窄 3 0 %左右。结论　颈动脉硬化内膜剥脱术为一种防治脑卒中的有效方法 ,在颈动脉转流管保护下手术更为安全。     

颈动脉狭窄的外科手术治疗

目的探讨颈动脉内膜切除术(CEA)治疗颈动脉狭窄的疗效。方法对2001年1月—2011年5月90例颈动脉狭窄患者行颈动脉内膜切除术93次,其中男78例,女15例;年龄50～78(平均65.6岁)。术前有短暂性脑缺血发作62例(TIA),31例术前患过脑梗死。所有患者术前均行脑血管造影和\或CTA明确颈动脉狭窄,狭窄程度均>80%。对侧颈动脉狭窄或闭塞者22例。结果 90例术后临床症状改善,包括TIA消失,记忆力明显好转,语言障碍恢复等。术后80例获得随访1～36个月。15例发现有手术部位再狭窄,狭窄率小于25%,其中1例脑卒中,1例TIA保守治疗好转。其余13例无临床症状。结论颈动脉内膜切除术是治疗颈动脉狭窄的安全、有效的方法。     

颈动脉内膜剥脱术治疗颈动脉重度狭窄30例体会

目的 探索如何更快度过颈动脉内膜剥脱术治疗颈动脉重度狭窄的学习曲线。方法 2015年6月至2022年9月采用颈动脉内膜剥脱术治疗颈动脉狭窄患者30例研究，术前完成病情评估和危险因素分析，术中根据患者情况选择补片和转流管，严格血压管控，术后双抗药物维持，控制并发症发生。术后长期随访，观察有无缺血性脑血管事件发生。结果 30例患者均顺利完成颈动脉内膜剥脱术，技术成功率100%，其中1例患者术后15个月发现颈内动脉远端吻合口再狭窄。其余患者随访时间内均未发现手术侧出现需要临床干预的再狭窄。围手术期患者未出现症状性脑出血，脑梗死，高灌注和死亡等严重并发症。最短随访1个月，最长随访7年零3个月，无短暂性脑缺血发作，脑卒中发生，有2例死亡，但均与脑卒中事件无关。结论 完善的术前评估，精细的术中操作，严格的术后管理可以让单中心开展颈动脉内膜剥脱术更快地度过学习曲线。     

Brener转流管在颈动脉内膜剥脱术中的应用

目的 探讨颈动脉内膜剥脱术中常规应用Brener转流管以保持颈动脉对脑持续供血的作用。方法 58例患者应用Brener。转流管完成颈动脉内膜剥脱术,并对围手术期并发症予以总结。结果 58例患者置放转流管成功率为100％。围手术期患者病死率及脑卒中发生率为0,但术后发生一过性脑缺血的患者有2例(3．5％),与手术操作有关的并发症为2例(3．5％),均为切口皮下血肿。结论术中常规应用Brener转流管是颈动脉内膜剥脱术成功的关键步骤之一,但其与术者詈前转流管的经验有直接关系。     

颈动脉狭窄合并冠心病的外科治疗

目的　探讨颈动脉狭窄合并冠心病患者行颈动脉内膜剥脱术的外科治疗特点。方法　在颈丛麻醉下 ,对 3 9例颈动脉狭窄合并冠心病患者行颈动脉内膜剥脱术 ,其中有 1例是在颈总动脉和颈内动脉之间建立分流后 ,再行颈动脉内膜剥脱术。结果　 3 9例手术 ,颈动脉平均阻断时间为 (2 7± 7)min ,术后 1例出现一过性神志欠佳 ,11例出现高血压 ,2例出现切口轻度肿胀 ,均康复出院。 2 5例术前有症状患者 ,术后症状明显改善 ,术后随访 4个月至 1年 ,均未出现一过性脑缺血发作或脑梗塞。结论　颈动脉狭窄合并冠心病患者应在冠状动脉旁路移植术前行颈动脉内膜剥脱术。颈丛麻醉可以很好地观察患者脑部供血情况 ,对于脑组织侧支循环不良者 ,采用自颈总动脉至颈内动脉建立分流 ,可以避免出现缺血性脑损伤。手术效果主要取决于术中操作 ,完整去除颈动脉内膜残片及碎屑、充分排气和术后控制高血压是关键     

冠心病合并颈动脉狭窄的围术期处理

背景 冠心病(coronary artery bypass grafting,CABG)合并颈动脉狭窄者临床上并不少见.如何正确处理CABG患者并存颈动脉狭窄的问题应引起重视.目的 为了探索CABG患者并存颈动脉狭窄的最佳处理方法,此文将CABG患者并存颈动脉狭窄的外科治疗及麻醉处理进行了分析汇总.内窖对于合并颈动脉狭...     

冠心病合并颈动脉狭窄的围术期处理

背景 冠心病(coronary artery bypass grafting,CABG)合并颈动脉狭窄者临床上并不少见.如何正确处理CABG患者并存颈动脉狭窄的问题应引起重视.目的 为了探索CABG患者并存颈动脉狭窄的最佳处理方法,此文将CABG患者并存颈动脉狭窄的外科治疗及麻醉处理进行了分析汇总.内窖对于合并颈动脉狭窄的CABG患者,最佳治疗策略尚未达成共识.既往外科治疗多采用分期或同期颈动脉内膜剥脱术(carotid endarterectomy,CEA),但近年来随着经皮介入治疗技术的发展,大多数可以采用分期或同期经皮颈动脉支架置人术(carotid artery stenting,CAS).CABG合并颈动脉狭窄患者围术期麻醉处理的关键是维持血流动力学平稳,保证大脑的有效灌注压,避免脑缺血和栓塞.趋向 同日CAS-CABG"杂交"手术已显示出可行性,并有待进一步研究.     

颈动脉内膜切除术治疗症状性颈动脉狭窄

目的:回顾性总结应用颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄的早期效果和经验。方法:对82例(男66例,女16例,年龄48～84岁,平均68.6岁)症状性颈动脉狭窄病人行CEA。全组均经颈部血管多普勒超声和数字减影血管造影术(DSA)确诊颈动脉粥样斑块形成、颈动脉狭窄。手术采用气管内插管全身麻醉39例,颈丛麻醉43例。术中放置动脉临时转流管56例,其中全麻应用39例,颈丛麻醉17例。结果:全组无死亡病例,脑缺血症状明显改善者65例,症状好转者14例,术后并发脑梗死2例,颈动脉内血栓形成1例。结论:CEA是治疗症状性颈动脉狭窄的有效方法。     

颈内动脉狭窄处扭曲的血管内治疗

目的 探讨血管内支架成形术治疗颈内动脉狭窄处扭曲的必要性、可行性和安全性.方法 选择2003年12月至2009年12月经数字减影血管造影(DSA)检查证实的症状性颈内动脉狭窄且狭窄处伴扭曲的12例患者,采用血管内支架成形术处理颈动脉狭窄伴扭曲,分析其临床、影像学、支架成形术和随访观察资料,评价治疗效果.结果 12例颈内动脉狭窄伴扭曲的患者全部成功实施血管内支架成形术,支架置入成功率100%,无支架相关死亡或致残.12例患者共置入自膨式支架14枚,平均狭窄率由术前的85.6%下降至11.2%;扭曲角度(Metz观测分类法)由术前＜90°变为＞120°;无围手术期短暂性脑缺血发作(TIA)和脑卒中发生,临床症状改善或消失.临床随访6～72个月,发生支架同侧和对侧TIA各1例;5例患者行DSA检查,其中1例发生再狭窄并在支架远端发生新的扭曲,再次支架置入治疗,2年后CT血管造影(CTA)复查未见扭曲和支架内再狭窄;另外7例行颈部血管超声检查,未见再狭窄和扭曲.结论 血管内支架成形术治疗颈内动脉狭窄伴扭曲,技术上是可行、安全的,可能有助于减少脑缺血发生,但有待于进一步观察.

Abstract：

Objective To study the necessity, feasibility, security of carotid angioplasty and stenting (CAS) for symptomatic carotid stenosis combined with kinking. Methods Twelve patients with symptomatic carotid stenosis and kinking demonstrated by digital subtraction angiography (DSA) received CAS from December 2003 to December 2009. There were 9 male and 3 female patients, age ranged from 59 to 77 years(mean 69.3 years). All the patients' clinical, imaging, intervention and follow up data were collected and analyzed. Results All CAS procedures were successfully performed with 14 self-expandable stents placed. The mean degree of stenosis was reduced from 85. 6% before stenting to 11.2% after stenting,the angle of kinking, according to Metz' category, were improved from less than 90° to more than 120° in each case. No perioperative procedure related stroke and tranient ichemic attack (TIA) occurred. The clinical symptoms and signs of cerebral ischemia were improved or disappeared for all patients. During follow-up of these 12 patients for 6 to 72 months, one patient experienced ipsilateral carotid territory TIA and another patient experienced contralateral carotid territory TIA. DSA follow up of 5 patients demonstrated 1 case with in-stent restenosis and arterial kinking remote to the stent of internal carotid artery. CAS were performed again and CT angiography follow up demonstrated no kinking and restenosis 2 years after the intervention. Duplex scan of the other 7 patients demonstrated neither kinking nor restenosis. Conclusions CAS seems to be feasible and safe for the patients with symptomatic kinking and stenosis, and maybe helpful to lower the risk of cerebral ischemia, but further study is needed.     

颈动脉外翻内膜剥脱术治疗颈动脉硬化狭窄

目的观察颈动脉外翻内膜剥脱术治疗颈动脉狭窄的疗效。方法24例颈动脉硬化狭窄患者,其中18例有慢性或一过性脑缺血症状,6例无症状;术前均行彩色超声、数字减影动脉造影(DSA)或CT和MRA扫描检查,颈动脉狭窄程度65％～95％;在颈丛麻醉下行颈动脉外翻内膜剥脱术,手术要点是于颈动脉分叉处斜形切断颈内动脉,外翻颈内动脉剥除有粥样斑块的内膜,同时从颈总动脉切口剥除颈总动脉和颈外动脉增厚的内膜。结果全组无手术死亡,术后随访3～20个月,临床症状均有不同程度改善,一过性脑缺血症状消失,4例仍有轻度慢性脑缺血症状。术后行脑部多普勒超声检查,22例脑部供血有明显改善。结论颈动脉外翻内膜剥脱术是一种安全、有效和合理的手术方式。     

Complications in carotid endarterectomy are predicted by qualifying symptoms and preoperative CT findings.

OBJECTIVES: To relate the 30-day perioperative rate of stroke or death in carotid endarterectomy (CEA) to preoperative qualifying symptoms and to the presence of cerebral infarction (CI) demonstrated on computed tomography (CT). DESIGN: Retrospective clinical study. MATERIAL AND METHODS: Two hundred and seventy-two consecutive CEAs for symptomatic stenosis in 262 patients were analysed. RESULTS: The total complication rate was 5.9%. Patients with retinal symptoms (n = 81) had no complications, TIA patients (n = 76) had 6.6% (p < 0.001). Patients qualifying with minor stroke (n = 113) had complications in 9.7% (N.S. compared to TIA patients). Patients qualifying with cortical symptoms had a significantly higher complication rate compared to those with retinal (8.4% vs. 0%, p = 0.004). The presence of a preoperative CT-verified infarction resulted in a higher risk for stroke or death (9.8% vs 2.8%, p = 0.008). Within the subgroup presenting with minor stroke, the presence of CI resulted in stroke or death in 13.9%. In patients without CI the corresponding figure was 2.4% (p = 0.017). CONCLUSION: The qualifying symptoms and the presence of CI visualized by CT influence the complication rate in CEA. When evaluating risk and comparing outcome, these parameters should be included in reporting standards.     

Simultaneous carotid and coronary artery surgery in asymptomatic carotid artery stenosis--report of three cases

Some patients with coronary artery disease are diagnosed as having additional carotid artery disease. This subset of patients has been identified as a high-risk group for cardiac and cerebral complications following surgical intervention. Three patients who underwent combined CEA/CABG for coexistent asymptomatic carotid occlusive disease are reported. Case 1: A 69-year-old female who suffered chest pain on exertion. Her coronary angiogram showed severe stenosis of three vessels. Her carotid angiogram showed 98% stenosis of the right internal carotid artery and poor collateral circulation. The severe stenosis of her carotid artery was considered as a risk factor for perioperative cerebral stroke. Intraoperatively, CEA preceded the CABG. Postoperative course was uneventful. Case 2: A 64-year-old male. Intermittent claudication was his initial symptom. His coronary angiogram showed stenosis in three vessels and carotid angiogram showed 75% stenosis in the right carotid artery. Simultaneous CABG and CEA was performed. His postoperative course was uneventful. Case 3: A 62-year-old male whose ECG indicated ischemic heart disease, although he had no symptoms. His coronary angiogram showed stenosis in three vessels, and 80% stenosis of his right carotid artery was observed by carotid angiogram. He underwent simultaneous surgery, and had an uneventful postoperative course. It has been reported that 1.5-8.7% of CABG patients have severe carotid artery stenosis, and perioperative cerebral stroke occurs in 0.9-16%. Simultaneous surgery was successful in our three patients who had asymptomatic carotid artery stenosis. Using this surgical approach for critical coexistent disease may minimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.     

颈动脉内膜剥脱术在治疗及预防缺血性脑卒中的临床研究

目的 观察颈动脉内膜剥脱术(CEA)对脑缺血症状的改善作用.方法 对80例颈动脉狭窄患者采用CEA治疗,剥离颈动脉斑块.结果 手术均获成功,术后患者脑缺血症状均有改善,未出现1例脑卒中和死亡病例,78例随访0.5~1.5 a未发生卒中病例.结论 CEA治疗颅外段颈动脉狭窄安全有效,对预防卒中、改善各种脑缺血症状具有重要...