Jimenez Juan C, Moore Wesley S, Lawrence Peter F, Quinones-Baldrich William J
Division of Vascular Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-6908, USA.
Ann Vasc Surg. 2008 Mar;22(2):179-84. doi: 10.1016/j.avsg.2007.08.002. Epub 2007 Nov 26.
As the number of carotid angioplasty and stent procedures increases, vascular surgeons should anticipate the need for increased surgical correction for complications of stenting and, particularly, in-stent restenosis. This study reviews operative technique alternatives for hemodynamically significant recurrent carotid stenosis following angioplasty and stent placement. Four techniques have been used for repair of carotid in-stent restenosis. All operations were performed with continuous electroencephalographic monitoring. Stents were completely removed in two patients. Operations performed were (1) longitudinal arteriotomy through the stent with patch angioplasty, (2) common carotid to distal internal carotid artery (ICA) bypass with polytetrafluoroethylene (PTFE), (3) subclavian to distal ICA bypass with PTFE, and (4) carotid endarterectomy with complete stent removal and patch angioplasty. Mean operative time was 133 +/- 22 min. Mean follow-up was 27.5 +/- 29 months. There were no postoperative strokes, myocardial infarctions, or deaths. No cranial nerve injuries were noted. No patients developed postoperative neck hematomas requiring return to the operating room. All patients were stable at follow-up without evidence of recurrent stenosis on postoperative duplex ultrasound. Repair of carotid restenosis following angioplasty and stenting can be achieved with or without complete stent removal. Multiple technical approaches may be required, depending on the length and location of the lesion and stents, the presence of complete common carotid occlusion, and the degree of surrounding inflammation.
随着颈动脉血管成形术和支架置入手术数量的增加，血管外科医生应预计到因支架置入并发症，尤其是支架内再狭窄而需要增加手术矫正的情况。本研究回顾了血管成形术和支架置入术后具有血流动力学意义的复发性颈动脉狭窄的手术技术选择。有四种技术用于修复颈动脉支架内再狭窄。所有手术均在连续脑电图监测下进行。两名患者的支架被完全移除。所进行的手术包括：（1）通过支架纵向切开动脉并进行补片血管成形术；（2）用聚四氟乙烯（PTFE）行颈总动脉至颈内动脉（ICA）远端旁路移植术；（3）用PTFE行锁骨下动脉至ICA远端旁路移植术；（4）颈动脉内膜切除术并完全移除支架及补片血管成形术。平均手术时间为133±22分钟。平均随访时间为27.5±29个月。术后无中风、心肌梗死或死亡病例。未发现颅神经损伤。没有患者出现需要返回手术室处理的术后颈部血肿。所有患者在随访时情况稳定，术后双功超声检查未发现再狭窄迹象。血管成形术和支架置入术后的颈动脉再狭窄修复可在不移除或移除支架的情况下实现。根据病变和支架的长度及位置、颈总动脉是否完全闭塞以及周围炎症程度，可能需要多种技术方法。
