CAJ | 학술논문

目的探讨外科手术方式治疗颈动脉支架术后再狭窄的可行性、安全性及有效性,并探讨术式选择和适应证.方法回顾性分析自2012年4月至2014年4月期间,上海长征医院血管外科收治的21例症状性颈动脉支架术后再狭窄患者.根据术前影像学检查结果及术中粘连情况综合分析,选择补片式颈动脉内膜切除(pCEA)支架取出术、外翻式颈动脉内膜切除(eCEA)支架取出术或颈动脉局段切除+人工血管间置术(CEGI)取出支架、重建血流.记录术中颈动脉转流管使用情况、出血量、手术时间、颈动脉阻断时间等.术后随访症状改善情况、有无围手术期并发症和再狭窄发生.结果共完成手术21例,其中pCEA支架取出术11例,eCEA支架取出术4例,CEGI 6例,所有支架均完整取出,技术成功率100％.使用颈动脉转流管14例,平均出血量(152.6±38.0)ml,平均手术时间(100.7 ±34.8)min,平均颈动脉阻断时间(29.1 ±4.6)min.术后早期并发颈部血肿1例、出现头痛、多语等大脑高灌注表现1例,3d内完全恢复.平均(13.2±4.3)个月随访,除1例术后21个月死于肺癌外,其余病例原症状改善明显,无神经损伤、短暂脑缺血发作(TIA)、卒中、心肌梗死或超过50％的再狭窄发生.结论采用外科手术方式取出支架-斑块复合物、重建血流,可行性好、疗效确切,兼具较好的安全性,为颈动脉支架术后再狭窄的治疗提供了新的选择.
목적 탐토외과수술방식치료경동맥지가술후재협착적가행성、안전성급유효성,병탐토술식선택화괄응증.방법 회고성분석자2012년4월지2014년4월기간,상해장정의원혈관외과수치적21례증상성경동맥지가술후재협착환자.근거술전영상학검사결과급술중점련정황종합분석,선택보편식경동맥내막절제(pCEA)지가취출술、외번식경동맥내막절제(eCEA)지가취출술혹경동맥국단절제+인공혈관간치술(CEGI)취출지가、중건혈류.기록술중경동맥전류관사용정황、출혈량、수술시간、경동맥조단시간등.술후수방증상개선정황、유무위수술기병발증화재협착발생.결과 공완성수술21례,기중pCEA지가취출술11례,eCEA지가취출술4례,CEGI 6례,소유지가균완정취출,기술성공솔100％.사용경동맥전류관14례,평균출혈량(152.6±38.0)ml,평균수술시간(100.7 ±34.8)min,평균경동맥조단시간(29.1 ±4.6)min.술후조기병발경부혈종1례、출현두통、다어등대뇌고관주표현1례,3d내완전회복.평균(13.2±4.3)개월수방,제1례술후21개월사우폐암외,기여병례원증상개선명현,무신경손상、단잠뇌결혈발작(TIA)、졸중、심기경사혹초과50％적재협착발생.결론 채용외과수술방식취출지가-반괴복합물、중건혈류,가행성호、료효학절,겸구교호적안전성,위경동맥지가술후재협착적치료제공료신적선택.
Objective To discuss the feasibility,safety and effectiveness of surgical management of post carotid artery stenting (CAS) restenosis,mainly focusing on the surgical options and indications.Methods This study represented retrospective analysis of 3 kinds of surgical managements of 21 patients with symptomatic post CAS restenosis from April 2012 to April 2014.Patch carotid endarterectomy (pCEA),Eversion carotid endarterectomy (eCEA) or carotid excision and graft interposition (CEGI) was selected to remove the stent and reconstruct the blood flow,based on the preoperative imaging results and intraoperative adhesion degree.Use of carotid shunt,blood loss,operative time,carotid artery cross-clamp time and other data were recorded.Patients were followed for improvement of symptoms,complications and restenosis.Results Eleven,4 and 6 patients received pCEA,eCEA or CEGI respectively.All the stents were successfully removed.Shunts were deployed in 14 cases.The mean bleeding was (152.6 ± 38.0) ml,the mean operation time was (100.7 ± 34.8) min and the mean carotid artery clamping time was (29.1 ± 4.6) min.In the early postoperative period,there were no infection,strokes,cranial nerve injury,myocardial infarction or mortalities.One patient developed neck hematoma,while 2 patients had the symptoms of hyperperfusion such as headache,irritability and multi-lingual but no intracranial hemorrhage happened according to the brain CT scan,who all fully recovered within 3 days.Within a median follow-up of (13.2 ± 4.3) months,no strokes,myocardial infarctions or recurrent restenosis (＞ 50％) on duplex ultrasound imaging or CTA was discovered except for 1 patient who died of lung cancer.Conclusion Surgical management to remove the stent and reconstruct the blood flow,which offered new options in the treatment of post CAS restenosis,with its initially confirmed simplicity,feasibility,safety and validity.