Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece.
J Vasc Surg. 2011 Aug;54(2):534-40. doi: 10.1016/j.jvs.2011.04.022.
High grade stenoses of both the innominate (IA) or common carotid artery (CCA) and the carotid bifurcation are rare and represent a therapeutic dilemma for the treating physician. A hybrid procedure with concomitant carotid endarterectomy (CEA) and retrograde angioplasty has been proposed as a less invasive treatment option. The aim of this study is to review the existing literature on such hybrid procedures.
An electronic search of the pertinent English literature was undertaken. A meta-analysis of all studies reporting on simultaneous carotid endarterectomy and retrograde angioplasty for the treatment of tandem internal carotid and proximal common carotid or innominate artery lesions was performed.
Thirteen studies, including 133 patients were identified. Sixty-eight percent of the patients were male, 83% symptomatic. Proximal lesions were located in ipsilateral CCA in 85 cases and in IA in 48 cases. Reported technical success of the procedure was 97%. In 79 of the 129 successful operations, a stent was implanted, while the remaining 50 patients underwent simple balloon angioplasty. Thirty-day mortality and stroke rate were 0.7% and 1.5%, respectively. Combined 30-day mortality and stroke rate was 1.5%. During a mean follow-up of 12 to 36 months, five patients presented symptoms of cerebral ischemia and 17 died. Ten patients developed restenosis of the proximal lesion, (4 symptomatic, 7 in cases without stent) and 2 restenoses of the endarterectomy (all asymptomatic). Restenosis was treated in 7 cases (4 repeat angioplasty, 3 bypass grafts).
This meta-analysis reports the largest collection of patients having undergone hybrid treatment of tandem disease of the arch vessels and carotid bifurcation. Results from this study show that the combined stroke and death rate with this approach is equal to or better than that for isolated endarterectomy. When possible, balloon angioplasty with stenting of the proximal component of this disease should be pursued to avoid restenosis.
无名动脉（IA）或颈总动脉（CCA）和颈动脉分叉处的高级别狭窄较为罕见，这给治疗医生带来了治疗上的困境。已经提出了一种联合颈动脉内膜切除术（CEA）和逆行血管成形术的杂交手术作为一种侵入性较小的治疗选择。本研究旨在回顾此类杂交手术的现有文献。
对相关英文文献进行了电子检索。对所有报告同时进行颈动脉内膜切除术和逆行血管成形术治疗串联颈内和近端颈总或无名动脉病变的研究进行了荟萃分析。
确定了 13 项研究，包括 133 名患者。68%的患者为男性，83%有症状。近端病变位于同侧 CCA 85 例，IA 48 例。报告的手术技术成功率为 97%。在 129 例成功手术中的 79 例中，植入了支架，而其余 50 例患者接受了单纯球囊血管成形术。30 天死亡率和卒中率分别为 0.7%和 1.5%。30 天死亡率和卒中率合并为 1.5%。在平均 12 至 36 个月的随访中，5 例出现脑缺血症状，17 例死亡。10 例近端病变出现再狭窄（4 例有症状，7 例无支架），2 例内膜切除术再狭窄（均无症状）。7 例患者（4 例再次血管成形术，3 例旁路移植术）治疗了再狭窄。
本荟萃分析报告了接受联合治疗弓状血管和颈动脉分叉处串联疾病的最大患者群体。本研究结果表明，这种方法的联合卒中率和死亡率与单纯内膜切除术相当或更好。在可能的情况下，应采用球囊血管成形术联合支架置入术治疗该疾病的近端病变，以避免再狭窄。
