Maiza D, Theron J
Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU Côte de Nacre, Caen.
J Mal Vasc. 1991;16(1):71-5; discussion 75-6.
The consequences of acute obstruction of the internal carotid artery or of its branches for the tissues depend on the efficiency of the mechanisms of hemodynamic and metabolic compensation of the cerebral blood flow. The occurrence of a neurologic deficit points out to insufficient compensation, but it does not allow assessing how irreversible the lesions are. The depth and duration of ischaemia are determining for the size of the residual infarct. Fast reperfusion of the ischaemic areas is aimed at limiting the size of the residual infarct but creates a risk of revascularization edema, and even of cerebromeningeal hemorrhage in case of ischaemic degradations of the blood-brain barrier. The indications of reperfusion are based on a pretherapeutic CT and angiographic assessment. The distal extension of thrombosis of the internal carotid artery as well as thrombosis or cruoric embolism of the carotid siphon or of the intracranial branches are not accessible to the conventional surgical reperfusion procedures but can be treated with local fibrinolytic infusion.
颈内动脉或其分支急性阻塞对组织的影响取决于脑血流动力学和代谢补偿机制的效率。神经功能缺损的出现表明补偿不足，但无法评估损伤的不可逆程度。缺血的深度和持续时间决定了残余梗死灶的大小。缺血区域的快速再灌注旨在限制残余梗死灶的大小，但会有发生再灌注水肿的风险，在血脑屏障缺血性降解的情况下甚至有发生脑脑膜出血的风险。再灌注的指征基于治疗前的CT和血管造影评估。颈内动脉血栓形成的远端延伸以及颈动脉虹吸部或颅内分支的血栓形成或血凝块栓塞无法通过传统的外科再灌注手术治疗，但可通过局部纤维蛋白溶解剂输注进行治疗。
