有症状的颈动脉慢性完全闭塞的杂交手术：技术说明
Hybrid surgery for symptomatic chronic total occlusion of carotid artery: a technical note.
作者信息
Shih Yu-Tung, Chen Wen-Hsien, Lee Wen-Lieng, Lee Hsu-Tung, Shen Chiung-Chyi, Tsuei Yuang-Seng
机构信息
Departments of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
Neurosurgery. 2013 Sep;73(1 Suppl Operative):onsE117-23; discussion onsE123. doi: 10.1227/NEU.0b013e31827fca6c.
BACKGROUND AND IMPORTANCE
Although medical treatment has been considered a dogma for chronic total occlusion (CTO) of the carotid artery, use of endovascular recanalization has also been reported. However, there are some difficulties in performing endovascular recanalization. We present the novel technical details and advantages of hybrid surgery for recanalization of symptomatic CTO of the internal carotid artery (ICA).
CLINICAL PRESENTATION
Three cases with recurrent ischemic attacks due to thrombotic occlusion of the right ICA above the bifurcation were successfully treated by this hybrid surgery, combining endarterectomy of the proximal ICA with endovascular angioplasty of the distal ICA. Using this hybrid technique, complete recanalization was achieved in all 3 cases. Follow-up computed tomography angiography with perfusion imaging showed improved brain perfusion. At 6-month follow-up, ischemic symptoms had not recurred.
CONCLUSION
We consider this hybrid surgery to be a feasible and good alternative surgical procedure for the treatment of CTO of the internal carotid artery.
背景与重要性
尽管药物治疗一直被视为颈动脉慢性完全闭塞（CTO）的治疗原则，但也有报道称可采用血管内再通术。然而，进行血管内再通术存在一些困难。我们介绍了用于有症状的颈内动脉（ICA）CTO再通的杂交手术的新技术细节和优势。
临床表现
3例因右侧ICA分叉上方血栓形成闭塞导致反复缺血发作的患者通过这种杂交手术成功治疗，该手术将近端ICA内膜切除术与远端ICA血管内血管成形术相结合。采用这种杂交技术，所有3例均实现了完全再通。随访的计算机断层扫描血管造影及灌注成像显示脑灌注改善。在6个月的随访中，缺血症状未复发。
结论
我们认为这种杂交手术是治疗颈内动脉CTO的一种可行且良好的替代手术方法。
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