Abou-Zamzam Ahmed M, Moneta Gregory L, Landry Gregory J, Yeager Richard A, Edwards James M, McConnell Donald B, Taylor Lloyd M, Porter John M
Department of Surgery, Division of Vascular Surgery, Oregon Health Sciences University, Portland Veterans Affairs Medical Center, USA.
Vasc Endovascular Surg. 2002 Jul-Aug;36(4):263-70. doi: 10.1177/153857440203600403.
With the perceived high risk of repeat carotid surgery, carotid angioplasty and stenting have been advocated recently as the preferred treatment of recurrent carotid disease following carotid endarterectomy. An experience with the operative treatment of recurrent carotid disease to document the risks and benefits of this procedure is presented. A review of a prospectively acquired vascular registry over a 10-year period (Jan. 1990-Jan. 2000) was undertaken to identify patients undergoing repeat carotid surgery following previous carotid endarterectomy. All patients were treated with repeat carotid endarterectomy, carotid interposition graft, or subclavian-carotid bypass. The perioperative stroke and death rate, operative complications, life-table freedom from stroke, and rates of recurrent stenosis were documented. During the study period 56 patients underwent repeat carotid surgery, comprising 6% of all carotid operations during this period. The indication for operation was symptomatic disease recurrence in 41 cases (73%) and asymptomatic recurrent stenosis >/=80% in 15 cases (27%). The average interval from the prior carotid endarterectomy to the repeat operation was 78 months (range 3 weeks-297 months). The operations performed included repeat carotid endarterectomy with patch angioplasty in 31 cases (55%), interposition grafts in 19 cases (34%), and subclavian-carotid bypass in 6 cases (11%). There were three perioperative strokes with one resulting in death for a perioperative stroke and death rate of 5.4%. One minor transient cranial nerve (CN IX) injury occurred. Mean follow-up was 29 months (range, 1-116 months). Life-table freedom from stroke was 95% at 1 year and 90% at 5 years. Recurrent stenosis (>/=80%) developed in three patients (5.4%) during follow-up, including one internal carotid artery occlusion. Two patients (3.6%) underwent repeat surgery. Repeat surgery for recurrent cerebrovascular disease following carotid endarterectomy is safe and provides durable freedom from stroke. Most patients are candidates for repeat endarterectomy with patching, but interposition grafting is often required. These results strongly support the continued role of repeat carotid surgery in the treatment of recurrent carotid disease.
鉴于人们认为再次进行颈动脉手术的风险很高，近年来，颈动脉血管成形术和支架置入术被推崇为颈动脉内膜切除术后复发性颈动脉疾病的首选治疗方法。本文介绍了复发性颈动脉疾病手术治疗的经验，以记录该手术的风险和益处。回顾了一个前瞻性获得的血管登记处10年期间（1990年1月至2000年1月）的资料，以确定先前接受过颈动脉内膜切除术的患者再次接受颈动脉手术的情况。所有患者均接受再次颈动脉内膜切除术、颈动脉间置移植术或锁骨下-颈动脉旁路移植术治疗。记录围手术期的卒中及死亡率、手术并发症、生存表法计算的无卒中生存率以及再狭窄率。在研究期间，56例患者接受了再次颈动脉手术，占该期间所有颈动脉手术的6%。手术指征为41例（73%）有症状的疾病复发和15例（27%）无症状性复发性狭窄≥80%。从先前颈动脉内膜切除术至再次手术的平均间隔时间为78个月（范围3周-297个月）。所施行的手术包括31例（55%）带补片血管成形术的再次颈动脉内膜切除术、19例（34%）间置移植术和6例（11%）锁骨下-颈动脉旁路移植术。围手术期发生3例卒中，1例导致死亡，围手术期卒中及死亡率为5.4%。发生1例轻微短暂性颅神经（IX）损伤。平均随访29个月（范围1-116个月）。生存表法计算的1年无卒中生存率为95%，5年为90%。随访期间3例患者（5.4%）出现再狭窄（≥80%），包括1例颈内动脉闭塞。2例患者（3.6%）接受了再次手术。颈动脉内膜切除术后复发性脑血管疾病的再次手术是安全的，且能持久预防卒中。大多数患者适合行带补片的再次内膜切除术，但常需要进行间置移植术。这些结果有力地支持了再次颈动脉手术在复发性颈动脉疾病治疗中的持续作用。
