Illuminati Giulio, Ricco Jean-Baptiste, Caliò Francesco G, D'Urso Antonio, Ceccanei Gianluca, Vietri Francesco
Francesco Durante Department of Surgery, La Sapienza University, Rome, Italy.
Surgery. 2008 Jan;143(1):134-9. doi: 10.1016/j.surg.2007.07.029. Epub 2007 Dec 3.
Although there is a growing body of evidence to document the safety and efficacy of operative treatment of carotid stenosis, surgical indications for elongation and kinking of the internal carotid artery remain controversial. The goal of this study was to evaluate the efficacy of surgical correction of internal carotid artery kinking in patients with persistent hemispheric symptoms despite antiplatelet therapy.
A consecutive series of 81 patients (mean age, 64 years) underwent 83 surgical procedures to correct kinking of the internal carotid artery either by shortening and reimplanting the vessel on the common carotid artery, inserting a bypass graft, or transposing the vessel onto the external carotid artery. Mean follow-up was 56 months (range, 15-135 months). Study endpoints were 30-day mortality and any stroke occurring during follow-up.
No postoperative death was observed. The postoperative stroke rate was 1%. Primary patency, freedom from neurologic symptoms, and late survival at 5 years (x +/- standard deviation) were 89 +/- 4.1%, 92 +/- 4%, and 71 +/- 6%, respectively.
The findings of this study indicate that surgical correction for symptomatic stenotic kinking of the internal carotid artery is safe and effective in relieving symptoms and preventing stroke. Operative correction should be considered as the standard treatment for patients with symptomatic carotid kinking that does not respond to antiplatelet therapy.
尽管有越来越多的证据证明颈动脉狭窄手术治疗的安全性和有效性，但颈内动脉延长和扭结的手术指征仍存在争议。本研究的目的是评估在接受抗血小板治疗后仍有持续性半球症状的患者中，手术矫正颈内动脉扭结的疗效。
连续81例患者（平均年龄64岁）接受了83次手术，通过缩短颈内动脉并将其重新植入颈总动脉、插入旁路移植物或把该血管移位到颈外动脉来矫正颈内动脉扭结。平均随访时间为56个月（范围15 - 135个月）。研究终点为30天死亡率和随访期间发生的任何卒中。
未观察到术后死亡。术后卒中发生率为1%。5年时的一期通畅率、无神经症状率和晚期生存率（x±标准差）分别为89±4.1%、92±4%和71±6%。
本研究结果表明，手术矫正有症状的颈内动脉狭窄性扭结在缓解症状和预防卒中方面是安全有效的。对于对抗血小板治疗无反应的有症状颈动脉扭结患者，手术矫正应被视为标准治疗方法。
