Owens Erik L, Kumins Norman H, Bergan John J, Sparks Steve R
Division of Vascular Surgery, Department of Surgery, University of California, San Diego, CA, USA.
Ann Vasc Surg. 2002 Mar;16(2):168-75. doi: 10.1007/s10016-001-0152-2. Epub 2002 Mar 15.
Carotid artery angioplasty with stenting (CAS) is being increasingly used in the treatment of extracranial carotid artery stenosis. As in other catheter-based approaches to the treatment of arterial disease, surgical intervention may be required because of either acute complications or correct critical restenosis. We have reviewed our experience managing early complications and critical in-stent restenoses after CAS in a tertiary care university hospital and a Veterans Affairs Medical Center. During the last 5 years, 22 carotid arteries (21 patients) underwent CAS. One patient developed thrombosis and rupture of the carotid artery during stenting. Two other patients (3 arteries) developed critical restenosis within 12 months. Subsequent surgical reconstructions included an internal carotid artery (ICA)-to-external carotid artery (ECA) transposition and a common carotid artery (CCA)-to-ICA bypass with reversed saphenous vein (RSV). The patient who underwent CCA-to-ICA bypass later required subclavian-to-ICA bypass because of rapidly progressive intimal hyperplasia and subsequent occlusion of the CCA. The other patient has not had surgical repair because of his deteriorating condition and significant co-morbidities. During the same time period, two additional patients were referred from outside institutions specifically for surgical intervention after carotid stenting. One had delayed rupture of the carotid artery 1 day after stenting and underwent urgent surgical repair. Another patient had early, critical restenosis within the stent and underwent placement of a CCA-to-ICA interposition graft using RSV. Acute treatment failures after CAS can be successfully managed using standard surgical techniques. Patients who develop critical in-stent restenosis requiring surgical repair may need more challenging surgical reconstructions to maintain cerebral perfusion.
颈动脉血管成形术联合支架置入术（CAS）在颅外颈动脉狭窄治疗中的应用越来越广泛。与其他基于导管的动脉疾病治疗方法一样，由于急性并发症或纠正严重再狭窄，可能需要进行手术干预。我们回顾了在一所三级医疗大学医院和一家退伍军人事务医疗中心对CAS术后早期并发症和支架内严重再狭窄的处理经验。在过去5年中，22条颈动脉（21例患者）接受了CAS。1例患者在支架置入过程中发生颈动脉血栓形成和破裂。另外2例患者（3条动脉）在12个月内出现严重再狭窄。后续的手术重建包括颈内动脉（ICA）至颈外动脉（ECA）转位和大隐静脉（RSV）逆行的颈总动脉（CCA）至ICA搭桥术。接受CCA至ICA搭桥术的患者后来因内膜增生迅速进展及随后的CCA闭塞而需要锁骨下动脉至ICA搭桥术。另1例患者由于病情恶化和严重的合并症而未进行手术修复。在同一时期，另外2例患者从外部机构转诊而来，专门针对颈动脉支架置入术后的手术干预。1例患者在支架置入后1天出现颈动脉延迟破裂，接受了紧急手术修复。另1例患者在支架内出现早期严重再狭窄，接受了使用RSV的CCA至ICA间置移植术。CAS术后的急性治疗失败可以通过标准手术技术成功处理。发生需要手术修复的支架内严重再狭窄的患者可能需要更具挑战性的手术重建来维持脑灌注。
