颅外段颈动脉狭窄的治疗策略

目的：探讨颅外段颈动脉粥样硬化性狭窄的治疗方法。方法回顾性分析上海中山医院血管外科2012年1～6月51例颅外段颈动脉粥样硬化性狭窄患者的临床资料，16例行颈动脉内膜剥脱术（carotid endarterectomy，CEA），35例行颈动脉支架置入术（ carotid artery stenting ，CAS）。结果51例手术均获成功，1例CAS术后即刻脑卒中，1例CEA术后第3天短暂性脑缺血发作（transient ischemic attack，TIA），1例CAS术后颈动脉窦压迫。全组术后随访9～15个月，平均13．6月，复查颈动脉B超，无严重再狭窄。结论根据颅外段颈动脉粥样硬化性狭窄患者的相关医学资料，对于有下列情况之一的患者我们倾向于行CEA：①6个月内1次或多次TIA，且颈动脉狭窄度≥70％；②6个月内1次或多次轻度非致残性卒中发作，症状或体征持续超过24小时且颈动脉狭窄度≥70％；③对于经颈部血管CTA和颈动脉全脑血管造影发现的颈动脉狭窄段≥2 cm。对于有下列情况之一的患者我们倾向于行CAS：①无症状性颈动脉狭窄度≥70％；②有症状性狭窄度范围50％～69％；③无症状性颈动脉狭窄度＜70％，但血管造影或其他检查提示狭窄病变处于不稳定状态。

Treatment Strategy of Extracranial Carotid Artery Stenosis

Objective To discuss the therapeutic method of extracranial athemsclerotic carotid artery stenosis . Methods A retrospective analysis was conducted in 51 patients with angiography confirmed carotid artery stenosis from January 2012 to June 2012 in our hospital.The carotid endarterectomy （CEA） was performed in 16 cases, while the carotid artery stenting （CAS） was performed in 35 cases. Results All the 51 operations were successfully completed .There were 1 case of transient ischemic attack （ TIA） 3 days after CEA operation , 1 case of postoperative stroke after CAS operation , and 1 case of carotid sinus pressure after CAS operation . The follow-up period of all the cases was 9-15 months, with an average of 13.6 months.Ultrasound review of the carotid artery found no restenosis. Conclusion According to medical information of the patients with extracranial carotid atherosclerotic stenosis , we tend to adopt the CAS treatment in patients with following situations： ①transient ischemic attack at least once within 6 months, with symptoms or signs lasting for more than 24 hours and the degree of carotid stenosis ≥70%;②mild than disabling stroke onset at least once within 6 months, with symptoms or signs lasting for more than 24 hours and the degree of carotid stenosis ≥70%; ③carotid artery stenosis ≥2 cm under neck vascular CTA and cerebral angiography .We tend to adopt CEA treatment in patients with following situations：①asymptomatic carotid stenosis with degree ≥70%;②symptomatic carotid stenosis with degree range from 50%to 69%;③asymptomatic carotid artery stenosis with degree 〈70%, but with instable situation of lesions under angiography or other examinations .