颈内动脉内膜剥除术治疗颈内动脉硬化闭塞症36例报告骀

目的探讨颈内动脉内膜剥除术治疗颅外段颈内动脉硬化闭塞症的方法和疗效.方法对36例颈内动脉硬化闭塞症病人分别采用颈内动脉内膜剥除加补片、颈内动脉外膜翻转内膜切除和人造血管置换三种不同的颈内动脉内膜剥除术式,通过治疗效果分析,总结手术经验及手术适应证.结果 36例病人痊愈出院,术后无并发症,随访期内无短暂性脑缺血发作(TIA)发作,彩超检查颈内动脉通畅.结论颈内动脉内膜剥除术是治疗颅外段颈内动脉硬化闭塞的有效方法.应根据颈内动脉病变程度和范围选取适当的手术方式.     

慢性颈内动脉闭塞的研究与治疗进展

现阶段临床工作中对慢性颈内动脉闭塞(ICACTO)治疗的认识有限。本文通过对慢性颈内动脉闭塞的病理、发病机制、临床症状、影像学特征及治疗等进行总结,综述其相关的研究进展。在颈内动脉完全闭塞后脑组织内丰富的侧支血管开放并逐步形成侧支代偿。ICACTO的病理生理特点是脑灌注不足,栓子脱落和认知功能障碍,最后引起多种卒中不良事件的发生。因此大多数ICACTO病例需要治疗。最初采取颈外动脉-颈内动脉搭桥的方法并没有取得满意的治疗效果。近年来闭塞血管的再通被认为是唯一可行的治疗手段,术前需要评估脑血管储备和氧摄取分数,以及颈内动脉(ICA)闭塞的长度、节段和闭塞时间等等多种因素。对合适的患者可以通过血管内介入,颈动脉内膜切除术(CEA)或复合手术等方法进行血管再通。随着生物材料的发展,简单的再通成功率会逐渐提高。但是,CEA+血管内介入的复合手术应该更符合当前的趋势,因为CEA可以切除颅外段颈动脉粥样硬化斑块,为进一步的血管内介入性提供条件。如果再通成功,通常可以长期稳定地改善患者状况。尽管现有的研究已经得出了一定的研究成果,但仍需要进一步的研究和试验来提高当前对ICACTO的了解。     

血管内开通微孔道型慢性颈内动脉闭塞2例

病例1:患者男,75岁,因“发作性头晕2个月”入院;高血压病史20年,否认糖尿病、冠心病病史,无烟酒嗜好。查体及实验室检查无明显异常。血管造影:Ⅲ型主动脉弓型,右侧颈内动脉C1段起始部次全闭塞,病变段呈“蜂窝”状或“网格”状改变(即存在微孔道),前向血流缓慢(图1A);影像学诊断:微孔道型颈内动脉慢性闭塞。行血管内开通术,将8F导引导管置于右侧颈总动脉远端,送入多功能导管(5F,125 cm),使其头端置位于右侧颈内动脉起始部,引入微导管(Ethelon-10)、微导丝(Pilot 50)组合,尝试沿微孔道通过病变失败;引入2.0 mm×15 mm球囊、微导丝(Pilot 50)组合,在小球囊支撑下,微导丝经反复尝试成功穿过(未完全循微孔道)病变段,并向上到达右侧颈内动脉C1远端(图1B),但球囊未能跟进;换用1.25 mm×15 mm球囊到达病变段并进行扩张后,再以2.0 mm×15 mm小球囊重复扩张。沿微导丝送入脑保护伞(Spider,5 mm)至右侧颈内动脉C1远段,沿保护伞导丝引入5 mm×30 mm球囊再次扩张病变段血管(图1C),最后植入颈动脉支架(Protege 8~6 mm×40 mm)(图1D)。术后血管造影示颈内动脉成功再通,患者头晕症状消失。     

颈内动脉内膜剥除术治疗颈内动脉硬化闭塞症36例报告

目的 探讨颈内动脉内膜剥除术治疗颅外段颈内动脉硬化闭塞症的方法和疗效。方法 对36例颈内动脉硬化闭塞症病人分别采用颈内动脉内膜剥除加补片、颈内动脉外膜翻转内膜切除和人造血置换三种不同的颈内动脉内膜剥除术式，通过治疗效果分析，主手术适应证。结果 36例病人痊愈出院，术后无并发症，随访期内无短暂性脑缺血发作（TIA）发作，彩超检查颈内动脉通畅。结论 颈内动脉内膜剥除术是治疗颅内外段颈内动脉硬化闭塞的有效方法。应根据颈内动脉病变程度和范围选取适当的手术方式。     

颈内动脉完全闭塞的手术治疗

目的 探讨颈动脉血运重建治疗完全性颈内动脉闭塞的临床疗效.方法 2001年6月～2010年4月,收治颈动脉狭窄患者397例,术前行磁共振血管造影(MRA)检查,确诊并行颈动脉内膜切除术(CEA)治疗颈内动脉闭塞患者28例,术中切除标本送病理检查,术后复查颈部MRA,并对术后情况进行随访.结果 术后即时通畅率为92.8％,术后平均随访时间10个月,22例颈内动脉通畅,通畅率为78.5％,无脑缺血事件发生;6例颈内动脉闭塞患者中,2例在术后4个月发生短暂性脑缺血及腔隙性梗死;3例术后仍偶有头晕,其中2例单侧肢体麻木;1例记忆力减退.结论 对于有症状的颈内动脉闭塞患者,CEA加取栓术是安全有效的方法.     

症状性颈内动脉闭塞的术前评估及手术治疗

目的:探讨症状性颈内动脉(ICA)闭塞患者手术治疗的效果和术前评价方法。方法:选择海南省人民医院血管外科2010年1月—2016年3月手术治疗的11例ICA闭塞的患者,2例行颈动脉内膜剥脱术(CEA),9例行CEA加取栓术。术前均行头颈联合CTA和颈部血管彩超,部分患者行脑CT灌注成像、经颅彩色多普勒超声以及脑血管造影等检查,观察患者围术期与长期疗效。结果:所有患者ICA闭塞均为单侧,其中4例对侧ICA有50%的狭窄。闭塞主要位于ICA起始端,8例闭塞段延至颅底,闭塞长度16~85 mm。术前颈动脉彩超均在可在颅底探及ICA血流。10例手术再通成功,1例失败。术后10例脑缺血症状明显改善,其中3例出现过度灌注综合征。随访期,1例患者ICA在术后3个月闭塞。1例在术后18个月死亡。结论:手术治疗ICA闭塞具有满意安全的围手术期效果和较好的中远期效果。术前精确的评估是手术成功的关键。     

颈内动脉硬化闭塞症手术三种术式的适应证和操作要点

欧美数个著名前瞻性研究及回顾性调查的结果证实颈内动脉内膜剥除术对防止脑血管意外具明显意义［１８３］。目前,颈内动脉内膜剥除术是欧美治疗颈内动脉硬化闭塞症的主要方法之一。我国开展此类手术较晚,仅在少数医院进行［４］。随着国人的生活水平提高和寿命的延长,此类疾病的发生率也在不断增高。因此,提高此类手术的整体水平具极其重要的意义。现将颈内动脉内膜剥除加补片修复、颈内动脉外膜翻转内膜切除及颈内动脉人造血管置换三种主要手术方式的适应证及操作要点归纳如下。颈内动脉硬化闭塞症外科手术指征　　１．绝对适应证［…     

远端球囊封堵技术在症状性非急性期颈内动脉闭塞开通术中的疗效观察

目的 探讨远端球囊封堵技术(BEPT)在症状性非急性颈内动脉闭塞(NICAO)开通术中的疗效.方法 收集2016年1月到2019年5月解放军联勤保障部队第九〇〇医院采用BEPT治疗症状性NICAO的13例患者临床资料,观察患者术前和术后14 d美国国立卫生院卒中量表(NIHSS)评分;术中使用支架的枚数;通过改良脑梗死...     

颈内动脉一侧闭塞另一侧高度狭窄的介入治疗

颈内动脉闭塞或狭窄多由动脉粥样硬化造成。颈动脉粥样硬化可引发脑梗塞 ,致残率及致死率均很高。一侧颈内动脉闭塞一侧高度狭窄 ,更易引起致命的脑梗塞 ,及时手术干预 ,是十分必要的。资料与方法1.一般资料 :搜集我院 1998年 1月至 2 0 0 2年 12月 ,一侧颈内动脉闭塞另一侧高度狭窄 ( >75 % )的患者 2 8例 ,颈内动脉狭窄 >90 %的有 9例 ,均经颈内动脉支架术 (CAS)治疗成功。男 2 1例 ,女 7例 ,年龄 4 8～ 74岁 ,平均 ( 6 7± 5 )岁。有临床症状者 2 6例 ,2例仅有狭窄侧颈动脉杂音。2 .方法 :( 1)影像学检查 :2 8例患者行CT、MRI,颈部血…     

颈动脉假性闭塞诊治进展

正对于颈动脉假性闭塞的概念,目前学界尚未统一。部分医师认为在CT血管造影(computed tomography angiography,CTA)过程中,颈内动脉末端的栓子或重度狭窄引起的串联型病变可导致血流极为缓慢,完成扫描时可在CTA上     

Trauma-related occlusion with spontaneous recanalization of the internal carotid artery

Summary. We present a case report concerning spontaneous recanalization of the internal carotid artery occlusion after an accident with contusion of the cerebrum and hyperextension trauma of the cervical spine.      

颈内动脉海绵窦段分支及其临床意义

目的　研究颈内动脉海绵窦段的分支的出现、起始、外径和分布等的显微外科解剖， 为海绵窦的显微手术的开展提供形态学依据。方法　采用经颈内动脉灌注苯乙烯的４６ 例成人头颅， 在手术显微镜（１０ 倍） 进行观察和测量。结果　颈内动脉海绵窦段由后向前分为后升部、后曲、水平部、前曲和前升部；颈内动脉此段分支有脑膜垂体干、小脑幕动脉、垂体下动脉、脑膜背侧动脉、海绵窦下动脉和垂体被囊动脉以及异常的眼动脉等， 其出现率分别为８７ ％ 、８７ ％ 、９４ ％ 、８１ ％ 、８８ ％ 、３２ ％ 和６ ％ 。结论　本文较系统、全面地阐明了海绵窦段的显微外科解剖，对临床进行显微外科手术、血管介入和影像学检查有指导意义     

Endovascular treatment of traumatic internal carotid artery pseudoaneurysm

IntroductionTraumatic internal carotid artery pseudoaneurysm (TICAP) is the most common cause of stroke in young adults. The treatment of TICAP with open surgery poses excess risk, thus during last decade endovascular treatment strategies have been applied.AimTo assess the efficacy and the existing experience of endovascular treatment of TICAP.MethodologyA systematic review of the literature was undertaken to identify all reported cases of endovascular treatment of TICAP from 1998 to 2015 in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials.ResultsA total of 193 patients (139 males, 75%) with mean age of 30.8 ± 2.2 years in 23 case studies, were treated for their TICAP with endovascular treatment. The main causes of TICAP were road traffic accidents 51%, assaults 12%, fall from height 8% and other miscellaneous causes were 29%. In 8/23 studies, the patients were operated emergently, in 9/23 at least 1 month after the carotid injury, and in 6/23 the time between the injury and the operation was not reported. The total success rate of pseudoaneurysm occlusion was 84% (162/193). The reported peri-procedural morbidity rate was 6% (11/185; 3 TIA, 7 strokes and 1 subclavian artery dissection), and the peri-operative mortality rate was 1.2% (2/162). Most patients received post-operatively antiplatelet therapy (either single or dual) and the duration of the administration ranged from 3 months to long term. During their follow up (ranging from 4 days to 13 years) only 6 patients required re-intervention, and this was undertaken with endovascular approach.ConclusionEndovascular therapy tends to be an effective option for the treatment of TICAP with low morbidity and mortality rates.     

Fenestration of the internal carotid artery

Fenestration of the internal carotid artery is very rare. The authors describe two cases of fenestration at the cervical portion of the internal carotid artery that were revealed by angiography. The embryological basis and clinical significance of this anomalous condition are discussed.     

Revascularization procedures in internal carotid artery pseudo-occlusion

Summary Background. Surgical treatment of patients with suspected internal carotid artery (ICA) pseudo-occlusion and reduced cerebrovascular reactivity (CVR) is still uncertain regarding the diagnostic procedures, the risks and the optimal timing as well as performance of revascularization.Method. From 1983–2001, 781 patients with symptomatic ICA stenosis were treated surgically. In 53 patients, a final diagnosis of extracranial ICA pseudo-occlusion was established by repeating Digital Subtraction Angiography (DSA). Angiographical findings were anterograde string-like filling of ICA beyond the carotid bifurcation or retrograde filling of the proximal, so called occluded extracranial ICA, extending up to the skull base. The CVR was reduced. All patients underwent direct surgery of extracranial carotid artery. Diagnostic parameters, peri-operative risks and postoperative course of these patients were evaluated.Findings. In 40 patients (75.5%) a successful revascularization of ICA was possible. ICA pseudo-occlusion was in all cases of atheromatous origin, moreover in 8 patients combined with a floating thrombus, distal to the stenosis. Thrombectomy was done by means of Fogarty catheter. In 13 patients (24.5%), a surgical re-opening of the ICA lumen was not possible. Five of these patients showed in DSA an anterograde string sign, eight presented retrograde filling of ICA reaching the skull base. Peri-operative mortality was 1.9%, peri-operative morbidity was 7.5%. After a 4 years (mean) follow-up, 95% of the reopened ICA remained patent.Conclusion. In patients with explicit carotid artery occlusion signs, careful selective DSA should be compulsory with a late series to detect ICA pseudo-occlusion. There is a chance for extracranial reopening ICA, even with compromised CVR, if anterograde string like or retrograde filling of proximal so called occluded ICA as far as the skull base is angiographically identified.     

Cerebral haemodynamics in internal carotid artery trial occlusion

Summary The purpose of this study was to analyse the cerebral haemodynamic changes brought about by trial occlusion of the internal carotid artery (ICA). Sixteen patients with surgically inaccessible cerebral aneurysms, carotid cavernous fistulas or neck neoplasms were monitored with transcranial Doppler ultrasonography (TCD) during 90–120 s angiographie ICA balloon occlusion or ICA closure with a Selverstone clamp. The blood velocity (V) was registered continuously in both middle cerebral arteries (MCA) while the pulsatility index (PI_MCA) and haemodynamic tension (U_hemmca ) were calculated.ICA closure led to an instantaneous drop in the ipsilateral V _mca , PI _mca and U_hemmca . The V _mca thereafter increased gradually until reaching a stable level. The subjects were grouped into those with initial drops in V _mca to 60% of pre-occlusion value (group 1) and those that fell to < 60% (group 2), respectively. In group 1 autoregulatory mechanisms made the PI _mca decline further, while the U_hemmca remained unaltered during ICA closure. In group 2, however, the PI _mca did not change further, while the U_hemmca increased slightly. The cerebral haemodynamic features during ICA test occlusion were thus essentially different in the two groups. On re-opening the ICA, there was an overshoot in V _mca and U_hemmca . Contralaterally, the V _mca was increased during ICA occlusion.Seven of the patients later had their ICA closed permanently. While none of five group 1 patients developed haemodynamic complications, two group 2 individuals experienced haemodynamic stroke. Assuming ICA sacrifice is feasable when test occlusion results in an ipsilateral initial reduction in V _mca to 60% of preocclusion value, the corresponding limit for the U_hemmca is 40%. In the pre-operative evaluation of the haemodynamic risk related to ICA loss, TCD emerges as a reliable method. It also seems to allow for the reduction of test occlusion time to 90–120 s.     

Successful intra-arterial fibrinolysis of the anterior choroidal artery in the acute stage of internal carotid artery occlusion: Case report

A 27-year-old man was admitted to our institution with the sudden development of right hemiparesis and dysarthria beginning an hour after the onset of symptoms on August 9, 1992. The patient was found on admission to have right hemiparesis (2/5), hemihypesthesia, hemianopia, dysarthria; he had transient atrial fibrillation. No abnormalities were detected on computed tomography (CT) scans, and cerebral blood flow studies undertaken following conventional CT scans revealed no low flow regions in the left cerebral hemisphere. But cerebral angiography disclosed an occlusion of the left internal carotid artery with well-developed cross-circulation via the anterior communicating artery and embolus lodged at the level of the anterior choroidal artery. Superselective fibrinolysis using Tracker-18 and 420,000 units of urokinase resulting in complete recanalization of the left anterior choroidal artery without distal migration of the embolus. Immediately after the procedure, his neurologic disturbance underwent complete resolution.

In summary, fibrinolysis could be performed but limited to anterior choroidal artery in a case with an occlusion of the internal carotid artery with well-developed cross-flow via the anterior communicating artery; the patient's neurologic condition may deteriorate suddenly if fibrinolysis is incomplete and the embolus migrates to the internal carotid artery.     

血管内治疗外伤性颈内动脉损伤

目的探讨血管内治疗对外伤性颈内动脉损伤的临床价值。方法16例外伤性颈内动脉损伤患者,经DSA造影证实为假性动脉瘤3例、岩部巨大蛇性动脉瘤及颈内动脉起始部动脉瘤各1例以及颈内动脉海绵窦瘘11例,分别采用可脱落球囊、电解可脱式弹簧圈（GDC）或带膜内支架对损伤部位进行动脉内栓塞治疗。结果对3例假性动脉瘤及1例岩部巨大蛇性动脉瘤患者以可脱落球囊闭塞患侧颈内动脉成功。9例颈内动脉海绵窦瘘（CCF）在保持颈内动脉通畅的情况下采用球囊成功栓塞瘘口,1例CCF予以GDC填塞海绵窦;其余1例CCF两次球囊栓塞均失败,但术后24h患侧凸眼明显回缩,间断按压患侧颈内动脉1周后患者临床症状和体征消失。1例颈内动脉起始部动脉瘤行带膜内支架成功植入,动脉瘤被旷置,颈内动脉保持通畅。结论血管内治疗是外伤性颈内动脉损伤安全有效的治疗方法。