University of Alberta, Division of Neurosurgery, Edmonton, Alberta, Canada.
Neurosurgery. 2012 Sep;71(1 Suppl Operative):182-4; discussion 185. doi: 10.1227/NEU.0b013e31824b131b.
Carotid body tumors are a technically challenging surgical problem. One of the primary goals of surgery and often one of the most difficult aspects of management involves preservation of the ipsilateral internal carotid artery (ICA). We report a small case series with challenging aspects to ICA preservation that were successfully treated with covered stenting and review the literature to date on this topic.
Two patients with carotid body tumors were selected for covered ICA stenting, the first because of bilateral disease and the second because of failure of test occlusion. The patients were initially loaded with antiplatelet agents, and the stents were deployed transfemorally. The patients were kept on dual therapy (acetylsalicylic acid and Plavix) for 6 weeks, followed by acetylsalicylic acid alone, which was discontinued 1 week before surgery. The patients were admitted 3 days before surgery, and intravenous heparin was started and then stopped 6 hours preoperatively. Both tumors were completely resected with minimal blood loss, and the ipsilateral ICA was successfully preserved in both cases.
The covered ICA stent offers a significant adjunct for preserving the ICA in carotid body tumor resection.
颈动脉体肿瘤是一项极具技术挑战性的手术难题。手术的主要目标之一，也是管理过程中最困难的方面之一，通常是保留同侧颈内动脉（ICA）。我们报告了一小部分病例系列，这些病例在 ICA 保护方面存在挑战性，通过覆膜支架成功治疗，并回顾了该主题的最新文献。
两名颈动脉体肿瘤患者被选择进行 ICA 覆膜支架置入，第一个患者因为双侧病变，第二个患者因为试验性闭塞失败。患者最初接受抗血小板药物治疗，支架通过股动脉置入。患者接受双联治疗（乙酰水杨酸和氯吡格雷）6 周，然后单独使用乙酰水杨酸，在手术前 1 周停用。患者在手术前 3 天入院，开始静脉注射肝素，并在术前 6 小时停止。两个肿瘤均完全切除，出血量少，同侧 ICA 在两种情况下均成功保留。
覆膜 ICA 支架为颈动脉体肿瘤切除中保留 ICA 提供了重要的辅助手段。
