颈动脉串联病变：血管造影检测频率及对内膜切除术的影响
Carotid artery tandem lesions: frequency of angiographic detection and consequences for endarterectomy.
作者信息
Rouleau P A, Huston J, Gilbertson J, Brown R D, Meyer F B, Bower T C
机构信息
Department of Diagnostic Radiology, Mayo Foundation, Rochester, MN 55905, USA.
出版信息
AJNR Am J Neuroradiol. 1999 Apr;20(4):621-5.
BACKGROUND AND PURPOSE
Several prospective trials have shown that ischemic stroke can be prevented by performing an endarterectomy in patients with high-grade carotid stenosis. Our purpose was to ascertain the frequency of carotid artery tandem lesions and to determine whether their presence alters the surgeon's decision to perform an endarterectomy.
METHODS
We retrospectively reviewed the cerebral angiograms obtained between January 1994 and June 1996 in 853 patients with carotid occlusive disease. Studies were analyzed for the presence of internal carotid artery (ICA) stenosis as well as for tandem lesions (defined as > or = 50% diameter stenosis) within the common carotid artery, carotid siphon, or proximal intracranial arteries. The frequency of intracranial saccular aneurysms was determined.
RESULTS
Six hundred seventy-two of the 853 patients had a carotid bifurcation stenosis of 70% or greater or underwent an endarterectomy. Of these, a carotid siphon stenosis of 50% or greater was noted in 65 patients (9.7%) and was ipsilateral to an ICA stenosis in 37 patients (5.5%). A common carotid stenosis was present in 29 patients (4.3%), ipsilateral to an ICA stenosis in 14 patients (2.1%). A stenosis of 50% or greater within the proximal intracranial circulation was present in 28 patients (4.2%), ipsilateral to an ICA stenosis in 15 patients (2.2 %). Four patients had tandem stenoses at more than one site. Tandem stenoses in the siphon or intracranial segments were noted in 13.5% with a bifurcation stenosis and in 8.8% of those with no bifurcation stenosis. Endarterectomy was performed in 48 of the 66 patients with tandem stenotic lesions.
CONCLUSION
The presence of a tandem lesion infrequently alters the surgeon's decision to perform an endarterectomy. However, the importance of detecting tandem stenoses cannot be underestimated, since they may have important implications for long-term medical management in symptomatic patients.
背景与目的
多项前瞻性试验表明，对重度颈动脉狭窄患者实施动脉内膜切除术可预防缺血性卒中。我们的目的是确定颈动脉串联病变的发生率，并确定其存在是否会改变外科医生实施动脉内膜切除术的决策。
方法
我们回顾性分析了1994年1月至1996年6月间853例颈动脉闭塞性疾病患者的脑血管造影。分析研究颈内动脉（ICA）狭窄的存在情况以及颈总动脉、颈动脉虹吸段或颅内近端动脉内的串联病变（定义为直径狭窄≥50%）。确定颅内囊状动脉瘤的发生率。
结果
853例患者中，672例有70%或更高的颈动脉分叉狭窄或接受了动脉内膜切除术。其中，65例（9.7%）患者存在50%或更高的颈动脉虹吸段狭窄，37例（5.5%）患者的虹吸段狭窄与同侧ICA狭窄相关。29例（4.3%）患者存在颈总动脉狭窄，14例（2.1%）患者的颈总动脉狭窄与同侧ICA狭窄相关。28例（4.2%）患者颅内近端循环存在50%或更高的狭窄，15例（2.2%）患者的颅内狭窄与同侧ICA狭窄相关。4例患者在多个部位存在串联狭窄。在有分叉狭窄的患者中，13.5%在虹吸段或颅内段存在串联狭窄；在无分叉狭窄的患者中，这一比例为8.8%。66例有串联狭窄病变的患者中，48例接受了动脉内膜切除术。
结论
串联病变很少改变外科医生实施动脉内膜切除术的决策。然而，检测串联狭窄的重要性不可低估，因为它们可能对有症状患者的长期医疗管理具有重要意义。
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