Terada Tomoaki, Tsuura Mitsuharu, Matsumoto Hiroyuki, Masuo Osamu, Tsumoto Tomoyuki, Yamaga Hiroo, Itakura Toru
Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan.
Neurosurgery. 2006 Aug;59(2):301-9; discussion 301-9. doi: 10.1227/01.NEU.0000222650.09509.DE.
The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition.
Twenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion.
All pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%.
The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.
颈内动脉（ICA）假性闭塞的手术获益存在争议。由于颈动脉内膜切除术治疗ICA假性闭塞的获益仍不明确，我们研究了使用颈动脉支架置入术作为这种情况的一种可能替代治疗方法。
20例颈动脉假性闭塞患者（17例有症状，3例无症状）接受了颈动脉支架置入术治疗。19例患者采用了各种栓子保护技术。我们研究了ICA假性闭塞的临床结果，包括血管造影随访数据、围手术期并发症以及栓子保护方法的有效性数据。
所有假性闭塞均成功扩张，狭窄率平均从95%降至6.7%。尽管有1例患者在治疗后1天死于心脏事件，但所有病例均未出现神经功能恶化。在平均24.8个月的随访期内，没有患者发生卒中，不过有1例患者死于心肌梗死。在支架置入术后6个月进行随访血管造影的17例患者中，只有1例出现再狭窄。该患者经重复经皮腔内血管成形术成功治疗。我们系列研究中的再狭窄率为5.9%，30天内的发病率/死亡率为5%。
从围手术期神经功能发病率、血管造影随访结果和预防卒中的角度来看，在栓子保护下进行颈动脉支架置入术治疗ICA假性闭塞的临床结果相当不错。对于患有ICA假性闭塞的患者，颈动脉支架置入术可被视为颈动脉内膜切除术的一种替代方法。
