Inoue Tomohiro, Tsutsumi Kazuo, Adachi Shinobu, Tanaka Shota, Kunii Naoto, Indo Masahiro
Department of Neurosurgery, Showa General Hospital, Kodaira-shi, Tokyo 187-8510, Japan.
Surg Neurol. 2008 Jun;69(6):620-6; discussion 626. doi: 10.1016/j.surneu.2007.01.034. Epub 2007 Sep 6.
Cerebral ischemia associated with chronic CCA occlusion is a rare condition and raises strategic dilemma when the revascularization is needed.
Two patients with CCA occlusion presented with ischemic symptom associated with the affected side. Both patients underwent vascular reconstruction by direct carotid endarterectomy to achieve primary restoration of CCA to ICA flow.
Successful reopening of the vessels was obtained in both patients without the evidence of postsurgical ischemic event. Follow-up MRA was obtained at later than 6 months after surgery, which demonstrated patent CCA-ICA in both patients.
Direct carotid endarterectomy of the occluded CCA can be safely performed if the preoperative angiography suggest still patent vessels distal to carotid bifurcation and the substantial "back flow" is obtained from ICA during arteriotomy.
与慢性颈总动脉闭塞相关的脑缺血是一种罕见情况，在需要进行血管重建时会引发策略性困境。
两名颈总动脉闭塞患者出现与患侧相关的缺血症状。两名患者均通过直接颈动脉内膜切除术进行血管重建，以实现颈总动脉至颈内动脉血流的初步恢复。
两名患者均成功实现血管再通，且无术后缺血事件的证据。术后6个月以上进行了随访磁共振血管造影，结果显示两名患者的颈总动脉 - 颈内动脉均通畅。
如果术前血管造影显示颈动脉分叉远端血管仍通畅，且在动脉切开术中从颈内动脉获得大量“反流”，则可安全地对闭塞的颈总动脉进行直接颈动脉内膜切除术。
