Adams C Z, Hoover E L, Vernillion B, Vincent G
Meharry Medical College, Nashville, Tennessee.
J Natl Med Assoc. 1991 Jan;83(1):69-72.
Crutchfield clamps were once widely used for proximal carotid artery ligation in the treatment of intracranial aneurysms and cavernous sinus fistulae. Consequently, there are a number of patients being followed who were treated with this device 10 to 15 years ago. The most important complication of this treatment modality in both the early and late postoperative period is thromboembolic phenomenon presenting as transient ischemic attacks, or a frank stroke. Because of the residual patient population with this device still in place, interval reports regarding the occurrence and treatment of late complications are important. We report a patient who underwent Crutchfield clamp application for control of a cavernous sinus fistula and had done well for 20 years when he developed transient ischemic attacks (TIA). Arteriography revealed a severe stenotic lesion (greater than 90%) in the common carotid artery with a patent internal carotid artery and no evidence of the previous fistula and an ulcerated plaque. At surgery, the pressure plate of the clamp had achieved an intraluminal position. The stenotic area was resected and an end to end anastomosis performed with complete resolution of symptoms after 18 months of follow-up. In this report we review the literature for complications of this device and discuss treatment options.
克氏夹曾经广泛用于颅内动脉瘤和海绵窦瘘的近端颈动脉结扎术。因此，有许多患者在10至15年前接受了该装置的治疗，目前仍在接受随访。这种治疗方式在术后早期和晚期最重要的并发症是血栓栓塞现象，表现为短暂性脑缺血发作或明显的中风。由于仍有使用该装置的患者群体，关于晚期并发症发生情况和治疗的间隔报告很重要。我们报告了一名患者，他因控制海绵窦瘘而应用了克氏夹，在20年里情况良好，但后来出现了短暂性脑缺血发作（TIA）。动脉造影显示颈总动脉有严重狭窄病变（大于90%），颈内动脉通畅，无先前瘘管的迹象，且有一个溃疡斑块。手术时，夹子的压板已进入管腔内位置。切除狭窄区域并进行端端吻合，随访18个月后症状完全缓解。在本报告中，我们回顾了关于该装置并发症的文献并讨论了治疗选择。
