Mracek J, Holecková I, Mork J, Sevcík P
Neurochirurgické oddelení FN, Plzen.
Cas Lek Cesk. 2009;148(7):326-9.
The preventive effect of carotid endarterectomy in the reduction of ischemic stroke was reliably confirmed. Carotid endarterectomy may also be a curative method, but it has not been confirmed yet. In our case report we illustrate the curative effect of carotid endarterectomy in a patient after a combined embolic and hemodynamic stroke. The administration of intravenous thrombolysis did not have the expected clinical response. Neuroimaging showed ischemia and homolateral hypoperfusion of the brain hemisphere caused by critical internal carotid artery stenosis. On the 8th day after thrombolysis a carotid endarterectomy was performed with beneficial effect. Normalization of hemodynamic in the altered hemisphere was demonstrated by perfusion examination along with the clinical improvement. A curative effect of endarterectomy appears more probable in a hemodynamic ischemic stroke. For the improvement of a neuronal function the existence of penumbra is a condition. While a positive influence of hemodynamic by carotid endarterectomy is confirmed, the possibility of an increase in neuronal activity after repair of vasomotor activity is not documented. The curative effect and it's connection to the timing of the carotid endarterectomy require testing in the further studies.
颈动脉内膜切除术在降低缺血性卒中方面的预防作用已得到可靠证实。颈动脉内膜切除术也可能是一种治愈方法，但尚未得到证实。在我们的病例报告中，我们阐述了颈动脉内膜切除术对一名合并栓塞性和血流动力学性卒中患者的治疗效果。静脉溶栓治疗未产生预期的临床反应。神经影像学显示，严重的颈内动脉狭窄导致脑半球缺血和同侧灌注不足。溶栓治疗后第8天进行了颈动脉内膜切除术，效果良好。灌注检查显示，病变半球的血流动力学恢复正常，临床症状也有所改善。内膜切除术对血流动力学性缺血性卒中似乎更有可能产生治疗效果。要改善神经元功能，半暗带的存在是一个条件。虽然颈动脉内膜切除术对血流动力学的积极影响已得到证实，但血管运动活动修复后神经元活动增加的可能性尚无文献记载。治疗效果及其与颈动脉内膜切除术时机的关系需要在进一步研究中进行验证。
