Cho Jae-Sung, Pandurangi Keshav, Conrad Mark F, Shepard Alexander S, Carr John A, Nypaver Timothy J, Reddy Daniel J
Surgery A011, University of Pittsburgh, Presbyterian University Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Vasc Surg. 2004 Jan;39(1):155-61. doi: 10.1016/j.jvs.2003.07.003.
With the recent emergence of carotid stenting in the management of carotid disease, the role of surgery has been challenged, particularly for recurrent carotid stenosis. This study was undertaken to determine the safety and durability of redo carotid operation (RCO) for recurrent stenosis.
A retrospective review identified 64 consecutive patients who underwent 66 RCOs between 1990 and 2000. There were 33 males (52%) and 31 females, with a mean age of 68.2 years (range, 38-84 years). The mean interval from the primary carotid surgery to RCO was 77.5 months (range, 1-292 months). Operative indications were severe asymptomatic stenosis in 33 cases (50%), transient ischemic attacks (TIA) or amaurosis fugax in 25 (38%), recent stroke in 6 (9%), and nonhemispheric symptoms in 1. Two operations were tertiary carotid reconstructions. A total of 56 (85%) patch angioplasties were performed, 49 with vein and 6 with synthetic material. Primary closure was performed in three cases (5%), whereas interposition grafts were required in eight (12%). Complete follow-up was available in 59 patients (92%) and averaged 4.3 years (range, 0.2-12.9 years); 97% of patients underwent follow-up duplex scanning.
There were no operative deaths and only two operative strokes (3.1%). Permanent cranial nerve deficit occurred in one patient (1.5%). Late stroke occurred in five patients: four ipsilateral and one contralateral. Kaplan-Meier estimates for 5- and 10-year stroke-free survival were 92% and 74%, and for overall survival were 72% and 50%. Duplex scanning detected significant recurrent carotid stenosis (>80%) or occlusion in six cases (9%) at a mean follow-up of 4.1 years. Kaplan-Meier estimates for freedom from recurrent stenosis of >80% were 94% and 86% at 5 and 10 years.
RCO for recurrent carotid stenosis can be performed safely with excellent protection from stroke and long-term durability. These data provide a standard against which the results of carotid stenting can be compared.
随着颈动脉支架置入术在颈动脉疾病治疗中的近期出现，手术的作用受到了挑战，尤其是对于复发性颈动脉狭窄。本研究旨在确定再次颈动脉手术（RCO）治疗复发性狭窄的安全性和耐久性。
一项回顾性研究确定了1990年至2000年间连续接受66次RCO的64例患者。其中男性33例（52%），女性31例，平均年龄68.2岁（范围38 - 84岁）。从初次颈动脉手术到RCO的平均间隔时间为77.5个月（范围1 - 292个月）。手术指征为：33例（50%）严重无症状狭窄，25例（38%）短暂性脑缺血发作（TIA）或一过性黑矇，6例（9%）近期卒中，1例非半球症状。2例为三级颈动脉重建术。共进行了56例（85%）补片血管成形术，49例用静脉，6例用合成材料。3例（5%）进行了一期缝合，8例（12%）需要置入移植血管。59例（92%）患者获得了完整随访，平均随访4.3年（范围0.2 - 12.9年）；97%的患者接受了随访双功超声扫描。
无手术死亡，仅2例手术相关卒中（3.1%）。1例患者（1.5%）出现永久性颅神经缺损。5例患者发生晚期卒中：4例为同侧，1例为对侧。Kaplan - Meier法估计5年和10年无卒中生存率分别为92%和74%，总生存率分别为72%和50%。双功超声扫描在平均4.1年的随访中发现6例（9%）有明显的复发性颈动脉狭窄（>80%）或闭塞。Kaplan - Meier法估计5年和10年无>80%复发性狭窄的概率分别为94%和86%。
复发性颈动脉狭窄的RCO可以安全进行，对卒中具有良好的预防作用且具有长期耐久性。这些数据提供了一个可与颈动脉支架置入术结果进行比较的标准。
