Zhou Wei, Lin Peter H, Bush Ruth L, Peden Eric, Guerrero Marlon A, Terramani Thomas, Lubbe Dieter F, Nguyen Liz, Lumsden Alan B
Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
J Vasc Surg. 2006 Mar;43(3):493-6; discussion 497. doi: 10.1016/j.jvs.2005.11.023.
Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period.
Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome.
A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by neurological symptoms (n=6, 14%). Twenty two (52%) were atherosclerotic aneurysms, fifteen (36%) false aneurysms, and five (12%) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five patients underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 patients underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69%).
Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.
颅外颈动脉动脉瘤（CCA）虽不常见，但对治疗策略构成挑战。本研究旨在分析20年间所有CCA患者的治疗演变及临床结果。
回顾了1984年至2004年期间所有诊断为CCA并接受干预的患者的临床资料。患者分为两组。比较第一组（1985 - 1994年）和第二组（1995 - 2004年）的临床表现、治疗方式及临床结果。
研究期间共发现42例CCA患者（第一组，n = 22；第二组，n = 20）。搏动性颈部肿块是最常见的症状（n = 39，93%），其次是神经症状（n = 6，14%）。22例（52%）为动脉粥样硬化性动脉瘤，15例（36%）为假性动脉瘤，5例（12%）为创伤后动脉瘤。两组的合并症和人口统计学特征相似。第一组所有患者均接受手术干预，其中12例行切除并置入旁路移植术（55%），6例行切除并补片血管成形术（27%），4例行颈动脉结扎术（18%）。第二组中，5例患者行切除并置入术（25%），1例行颈动脉结扎术（5%）。其余14例患者接受血管内介入治疗（70%），包括7例支架移植物封堵术、6例颈动脉支架置入并弹簧圈封堵术和1例血管内闭塞术。第二组的住院时间明显短于第一组（3.5天对9.4天，p<0.01）。第一组和第二组的颅神经损伤发生率分别为14%和5%（p<0.04）。第一组和第二组的30天死亡率/重大卒中发生率分别为14%和5%（p<0.04）。在随访期（0.8个月至20年；平均4.6年）内，16例患者死亡，主要死于心脏病因（n = 11，69%）。
在我们机构，CCA的治疗方式已从手术治疗大幅演变为血管内介入治疗。血管内治疗方式的益处包括康复期更短和手术相关并发症更少。这种演变反映了血管内设备的改进以及血管内应用的实用性增加。
