Aguiar Eduardo Toledo de, Lederman Alex, Matsunaga Patrícia
Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Sao Paulo Med J. 2002 Sep 2;120(5):154-7. doi: 10.1590/s1516-31802002000500007.
Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy.
To demonstrate the feasibility of retrograde common carotid endarterectomy.
Retrospective case report study.
Tertiary care private hospital.
Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded.
Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency.
There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up.
There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.
颈总动脉完全闭塞较为罕见，其手术治疗的适应证和技术仍存在争议。
证明逆行性颈总动脉内膜切除术的可行性。
回顾性病例报告研究。
三级护理私立医院。
3例患者接受了环状剥脱逆行性颈总动脉内膜切除术。他们的年龄分别为81岁、68岁和65岁。所有患者均患有高血压并伴有全身性动脉粥样硬化，2例患有糖尿病，1例几年前接受过冠状动脉搭桥手术且患有非透析性慢性肾功能不全。2例患者有脑缺血症状。所有患者的颈总动脉均完全闭塞，从起源处延伸至分叉处，2例位于右侧颈总动脉。2例患者的颈内动脉也闭塞。
术后早期死亡率和卒中率，以及中长期内膜切除术通畅率。
无死亡病例。1例患者发生短暂性脑缺血发作。所有内膜切除术在随访8个月、4年和7年后均保持通畅。
死亡率低，该手术仅通过一个颈部切口即可完成。颈动脉串联病变可一并治疗。它适用于颈总动脉的长段完全闭塞，且具有长期通畅性。
