Schievink W I, Thompson R C, Lavine S D, Yu J S
Department of Neurological Surgery, Cedars-Sinai Neurosurgical Institute, Los Angeles, Calif. 90048, USA.
Mayo Clin Proc. 2000 Oct;75(10):1087-90. doi: 10.4065/75.10.1087.
The recent proliferation of endovascular treatment of carotid atherosclerotic disease will increase the number of patients who require treatment for recurrent carotid stenosis after angioplasty and stent placement. The optimal management of these patients has not yet been defined. We describe a 66-year-old woman who required 2 surgical procedures for recurrent in-stent carotid stenosis. She experienced numerous transient ischemic attacks 5 months after left extracranial internal carotid artery angioplasty and stenting for asymptomatic stenosis. Angiography showed high-grade in-stent restenosis, left intracranial carotid artery stenosis, and poor collateral flow to the left middle cerebral artery circulation. The patient underwent a superficial temporal artery to middle cerebral artery bypass, and the transient ischemic attacks resolved. Five months later, angiography showed progressive stenosis of the external carotid artery at the site of the stent. The patient underwent successful external carotid reconstruction with an on-lay patch. Extracranial-intracranial bypass grafting may be used successfully in the treatment of recurrent extracranial carotid artery stenosis after angioplasty and stent placement. Also, external carotid artery reconstruction at the site of an internal carotid artery stent can be performed safely.
近期颈动脉粥样硬化疾病血管内治疗的迅速增多，将使血管成形术和支架置入术后需要治疗复发性颈动脉狭窄的患者数量增加。这些患者的最佳治疗方案尚未确定。我们描述了一名66岁女性，她因复发性支架内颈动脉狭窄接受了2次外科手术。她在左侧颅外颈内动脉血管成形术和支架置入治疗无症状狭窄5个月后，经历了多次短暂性脑缺血发作。血管造影显示支架内高度狭窄、左侧颅内颈动脉狭窄以及左侧大脑中动脉循环的侧支血流不佳。该患者接受了颞浅动脉至大脑中动脉搭桥手术，短暂性脑缺血发作得到缓解。5个月后，血管造影显示支架部位的颈外动脉出现进行性狭窄。该患者接受了成功的外置补片颈外动脉重建术。颅外-颅内搭桥术可成功用于治疗血管成形术和支架置入术后复发性颅外颈动脉狭窄。此外，在内颈动脉支架部位进行颈外动脉重建可以安全进行。
